OFFICE BASED IMAGING OF EARLY LARYNGEAL CANCER USING HIGH-SPEED FD-OCT

使用高速 FD-OCT 在办公室进行早期喉癌成像

• 批准号: 7722601
• 负责人: ZHONGPING CHEN
• 金额: $ 0.67万
• 依托单位: UNIVERSITY OF CALIFORNIA-IRVINE
• 依托单位国家: 美国
• 财政年份: 2008
• 资助国家: 美国
• 起止时间: 2008-04-15 至 2009-03-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/7722601
• 关键词: Alcohol consumption; Anesthesia procedures; Awareness; Biomedical Engineering; Biopsy; Chronic; Cigarette; Clinical; Computer Retrieval of Information on Scientific Projects Database; Connective Tissue; Device Designs; Devices; Diagnosis; Diagnostic; Disease; Dysphonia; Early Diagnosis; Emerging Technologies; Endoscopic Surgical Procedures; Endoscopy; Evaluation; Funding; Gap Junctions; Gastrointestinal tract structure; Grant; Hand; Head and neck structure; Hoarseness; Image; Imaging Device; Institution; Invasive; Laryngeal Diseases; Laryngeal neoplasm; Larynx; Light; Link; Magnetic Resonance Imaging; Malignant Neoplasms; Malignant neoplasm of larynx; Medicine; Microanatomy; Microinvasive; Microsurgery; Modality; Morbidity - disease rate; Newly Diagnosed; Nexus (resin cement); Numbers; Operative Surgical Procedures; Optical Coherence Tomography; Otolaryngologist; Patients; Primary Care Physician; Probability; Rate; Research; Research Personnel; Resources; Risk; Screening procedure; Sedation procedure; Signs and Symptoms; Smoke; Source; Speed; Staging; Structure; Surgeon; Symptoms; System; Techniques; Time; Tissues; Tobacco; Tobacco smoke; United States National Institutes of Health; Upper aerodigestive tract cancer; Voice; Work; base; cancer diagnosis; day; design; design and construction; instrument; non-smoker; optical imaging; tumor; two-dimensional; vocal cord

This subproject is one of many research subprojects utilizing the resources provided by a Center grant funded by NIH/NCRR. The subproject and investigator (PI) may have received primary funding from another NIH source, and thus could be represented in other CRISP entries. The institution listed is for the Center, which is not necessarily the institution for the investigator. Cancer of the upper aerodigestive tract is inextricably linked to the combined effect of chronic tobacco and alcohol use. Laryngeal cancer is very rare in nonsmokers, and the risk increases with numbers of cigarettes smoked per day. Approximately 15,000 laryngeal cancers are diagnosed each year, representing about 1.2% of all newly diagnosed cancers. Greater awareness of the signs and symptoms of laryngeal cancer by primary care physicians over the past decade has led to earlier diagnosis of laryngeal cancer, which presents quite subtly at earlier stages, with the cardinal symptom being voice change, specifically hoarseness. Since early diagnosis of laryngeal cancer results in a much higher cure rate (>90%) than late-stage disease (<60%), clinicians are aggressive with respect to obtaining vocal cord biopsies, even though this means many biopsies will yield a diagnosis that is not cancer. Vocal cord biopsy is not innocuous, and frequently leads to irreversible dysphonia and hoarseness as a consequence of removing the delicate viscoelastic connective tissues. Invasive laryngeal cancer is defined as the spread of vocal cancer into this same tissue. Diagnosing the presence or high likelihood of an invasive laryngeal tumor without biopsy would provide surgeons with the ability to better determine which patients are candidates for surgical endoscopy and biopsy. Likewise, many patients may be spared the morbidity associated with a vocal cord biopsy. An office-based, non-contact technique is needed to obtain real-time cross-sectional images of the vocal cord microstructure and hence aid in distinguishing invasive from non-invasive tumors. Such a device would allow relatively simple diagnostic screening of patients at high risk of or suspected as having laryngeal cancer and would allow evaluation of chronic laryngeal disease related to second-hand tobacco smoke exposure. We propose to accomplish this task by developing an advanced Optical Coherence Tomography (OCT)-based instrument to image the larynx in the office without the need for anesthesia or sedation. OCT is an emerging optical imaging modality that uses light to produce crosssectional images in tissue, which under we have pioneered use in more than 300 patients to image the upper aero-digestive tract in operative settings. The proposed research will design and develop OCT probes that will work in tandem with existing conventional office-based laryngeal endoscopy systems. We believe use of this emerging technology will ultimately 1) provide a means to screen patients for early laryngeal cancer and minimize the number of unnecessary biopsies performed to diagnose early laryngeal cancer, thus reducing iatrogenic dysphonia; 2) guide otolaryngologists during microsurgery to focus biopsies on regions with a higher probability of microinvasive cancer; and 3) allow archival storage of cross-sectional images of the vocal cord which can be used to determine changes in cord microanatomy and structure over time, augmenting conventional static two-dimensional laryngeal photographs. We firmly believe OCT has the potential to become as vital as CT and MRI for managing head and neck malignancies since it provides such exquisite detail on tissue microstructure; unlike these traditional imaging modalities, performing laryngeal OCT imaging in the office remains a major technical challenge, and therefore is now the main focus of our research. Our proposal is clinically driven and focuses bringing an advanced laryngeal imaging device into clinical practice and large scale evaluation. The technical challenges in device design lie at the nexus of medicine, surgery, and biomedical engineering. The specific aims are 1. Design and construct OCT probe that can be integrated with an office-based laryngeal endoscopy imaging system. 2. Perform large-scale screening of patients at risk of laryngeal cancer, and correlate F-OCT images with clinical findings and conventional video endoscopic images. 3. Correlate OCT vocal cord images with biopsies in the subset of patients undergoing microlaryngeal surgery for cancer diagnosis.

这个子项目是许多研究子项目中的一个 由NIH/NCRR资助的中心赠款提供的资源。子项目和 研究者（PI）可能从另一个NIH来源获得了主要资金， 因此可以在其他CRISP条目中表示。所列机构为 研究中心，而研究中心不一定是研究者所在的机构。 上呼吸消化道癌症与长期吸烟和饮酒的综合影响密不可分。喉癌在非吸烟者中非常罕见，并且风险随着每天吸烟的数量而增加。每年约有15，000例喉癌被诊断出来，占所有新诊断癌症的1.2%。在过去的十年里，初级保健医生对喉癌的体征和症状有了更多的认识，导致喉癌的早期诊断，在早期阶段表现得非常微妙，主要症状是声音变化，特别是声音嘶哑。由于喉癌的早期诊断导致比晚期疾病（<60%）高得多的治愈率（>90%），临床医生在获得声带活检方面是积极的，即使这意味着许多活检将产生不是癌症的诊断。声带活检并非无害，而且由于切除了脆弱的粘弹性结缔组织，经常导致不可逆转的发音困难和声音嘶哑。浸润性喉癌被定义为声带癌扩散到同一组织中。 在没有活检的情况下诊断浸润性喉肿瘤的存在或高可能性将为外科医生提供更好地确定哪些患者是手术内窥镜和活检的候选人的能力。同样，许多患者可能会避免与声带活检相关的发病率。需要一种基于办公室的非接触式技术来获取声带微观结构的实时横截面图像，从而帮助区分侵袭性肿瘤和非侵袭性肿瘤。这种装置将允许对处于喉癌高风险或疑似患有喉癌的患者进行相对简单的诊断筛查，并且将允许对与二手烟草烟雾暴露相关的慢性喉部疾病进行评估。我们建议通过开发一种先进的基于光学相干断层扫描（OCT）的仪器来完成这一任务，该仪器可以在办公室对喉部进行成像，而无需麻醉或镇静。OCT是一种新兴的光学成像模式，它使用光在组织中产生横截面图像，我们已经率先在300多名患者中使用它在手术环境中对上呼吸消化道进行成像。 拟议的研究将设计和开发OCT探头，将与现有的传统办公室喉内窥镜系统协同工作。我们相信，使用这项新兴技术最终将1）提供一种筛查早期喉癌患者的方法，并最大限度地减少诊断早期喉癌时不必要的活检次数，从而减少医源性发音困难; 2）指导耳鼻喉科医生在显微手术期间将活检集中在微侵袭性癌症概率较高的区域;以及3）允许声带的横截面图像的档案存储，其可用于确定声带显微解剖学和结构随时间的变化，增强常规的静态二维喉部照片。我们坚信OCT有可能成为与CT和MRI一样重要的头颈部恶性肿瘤的治疗方法，因为它提供了组织微观结构的精细细节;与这些传统的成像方式不同，在办公室进行喉部OCT成像仍然是一个主要的技术挑战，因此现在是我们研究的主要焦点。我们的建议是临床驱动的，重点是将先进的喉部成像设备引入临床实践和大规模评估。器械设计中的技术挑战在于医学、外科手术和生物医学工程的联系。 具体目标是 1.设计并构建可与基于诊所的喉内窥镜成像系统集成的OCT探头。 2.对有喉癌风险的患者进行大规模筛查，并将F-OCT图像与临床发现和传统视频内窥镜图像相关联。 3.将OCT声带图像与接受喉显微手术进行癌症诊断的患者亚组的活检结果相关联。