Early Detection and Diagnosis of Lung Cancer with Endomicroscopy

内镜下肺癌的早期发现和诊断

• 批准号: 10321206
• 负责人: Melissa J Suter
• 金额: $ 63.39万
• 依托单位: MASSACHUSETTS GENERAL HOSPITAL
• 依托单位国家: 美国
• 财政年份: 2021
• 资助国家: 美国
• 起止时间: 2021-01-01 至 2026-12-31
• 项目状态: 未结题
• 来源: https://reporter.nih.gov/project-details/10321206
• 关键词: Address; Advisory Committees; Benign; Biopsy; Biopsy Specimen; Blinded; Breast; Bronchoscopy; Cancer Etiology; Categories; Catheters; Cessation of life; Clinical; Clinical Research; Colon; Custom; Development; Diagnosis; Diagnostic; Diagnostic Procedure; Early Diagnosis; Early Intervention; Enrollment; Evaluation; Feasibility Studies; Goals; Histopathology; Image; Image Analysis; Individual; Laboratories; Lesion; Lung nodule; Malignant Neoplasms; Malignant neoplasm of lung; Methods; Microscopic; Microscopy; Morbidity - disease rate; Nodule; Operative Surgical Procedures; Optical Coherence Tomography; Optics; Pathologist; Pathology; Patients; Physicians; Preventive service; Procedures; Prostate; Randomized; Reader; Research Design; Resolution; Risk; Sheep; Site; Specimen; Survival Rate; Symptoms; Techniques; Technology; Therapeutic Intervention; Time; Tissue Sample; Tissue imaging; Tissues; Visualization; Work; arm; base; cancer diagnosis; computed tomography screening; diagnostic accuracy; falls; high resolution imaging; high risk; human subject; imaging approach; imaging platform; in vivo; low dose computed tomography; microendoscopy; minimally invasive; mortality; novel; optical imaging; public health relevance; safety study; screening; surgical risk; tool; tumor; tumor microenvironment

PROJECT SUMMARY Early diagnosis of lung cancer is critical to patient survival. Unfortunately the vast majority of cases are detected once symptoms arise and the cancer has spread offering patients little hope for cure (average 5-year survival rate < 15%). The U.S. Preventive Services Task Force recommends individuals at high risk of developing lung cancer undergo yearly screening with low dose computed tomography (LDCT). Screening is highly sensitive at detecting lung nodules and has resulted in a reduction in mortality of these patients, however only 5% of nodules detected are likely to be cancer. Diagnosis of lung cancer must be made on the microscopic level which is traditionally done by obtaining tissue specimens for subsequent histopathology examination. Methods for biopsy generally fall under two categories; high-risk surgical and transthoracic procedures that provide a higher diagnostic yield, and low-risk bronchoscopy based procedures that generally have a lower yield. Given that the vast majority of nodules detected by LDCT screening are benign it is critical that the high-risk procedures for diagnosis are avoided. The low diagnostic yields of bronchoscopy based biopsy procedures can be attributed to insufficiently large, inappropriately located, or non-diagnostic tissue sampling. Therefore there is a critical need to dramatically increase the diagnostic yield of low-risk bronchial biopsy approaches. In our laboratory we have developed novel optical coherence tomography (OCT) imaging approaches to provide high-resolution images of tissue microstructure. We have additionally developed and disseminated OCT interpretation criteria for the diagnosis lung cancer. In this proposal we aim to further develop our endobronchial OCT imaging catheters to provide images with superior resolution and contrast with the goal of microscopically guiding biopsy site selection to increase tumor yield (Aim 2), and to use our endomicroscopy images and previously developed image interpretation criteria to provide a preliminary diagnosis of the lesion within the procedure room (Aim 3). The intra-procedural diagnostic endomicroscopy images could be useful complementary information provided to pathologists in addition to the tiny physical biopsy specimens for diagnosis, or to enable immediate diagnosis and treatment of small lesions without requiring a second procedure.

项目概要 肺癌的早期诊断对于患者的生存至关重要。不幸的是，绝大多数情况都是 一旦出现症状并且癌症已经扩散，患者就几乎没有治愈的希望（平均 5 年） 存活率<15%）。美国预防服务工作组建议高风险人群 发展中的肺癌每年接受低剂量计算机断层扫描 (LDCT) 筛查。筛选是 在检测肺结节方面高度敏感，从而降低了这些患者的死亡率， 然而，检测到的结节中只有 5% 可能是癌症。肺癌的诊断必须根据 传统上通过获取组织标本进行随后的组织病理学检查来完成微观水平 考试。活检方法通常分为两类：高风险手术和经胸手术 提供更高诊断率的程序，以及通常基于低风险支气管镜检查的程序 产量较低。鉴于 LDCT 筛查检测到的绝大多数结节都是良性的，因此这一点至关重要 避免高风险的诊断程序。基于支气管镜的诊断率低 活检程序可归因于组织不够大、位置不当或无法诊断 采样。因此，迫切需要大幅提高低危支气管疾病的诊断率 活检方法。在我们的实验室中，我们开发了新型光学相干断层扫描 (OCT) 成像 提供组织微观结构高分辨率图像的方法。我们还开发了 传播OCT诊断肺癌的判读标准。在本提案中，我们的目标是进一步 开发我们的支气管内 OCT 成像导管，以提供具有卓越分辨率和对比度的图像 显微镜引导活检部位选择以增加肿瘤产量的目标（目标 2），并使用我们的 内窥镜图像和先前制定的图像解释标准可提供初步的 手术室内病变的诊断（目标 3）。术中诊断内窥镜检查 除了微小的物理信息之外，图像还可以成为向病理学家提供的有用的补充信息。 活检标本用于诊断，或能够立即诊断和治疗小病变，而无需 需要进行第二次手术。