Endoscopic optical coherence tomography and autofluorescence imaging for early cancer detection

在加拿大，肺癌是癌症死亡的主要原因，占男性和女性癌症死亡人数的四分之一以上。国家肺部筛查试验显示，与标准胸部x线相比，低剂量螺旋CT成像可以使高危吸烟者的癌症死亡率降低20%，主要是通过检测早期癌症结节，这些结节大多数很小（<9mm），位于肺周围。为了明确的肺癌诊断和治疗计划，医生必须定位和取样疑似肺癌结节。对肺结节进行定位和取样的最安全方法是使用支气管镜；然而，它们太大，无法进入周围的小气道。我们最近率先开发了一种直径为0.9毫米的新型光纤成像导管，有望用于定位周围肺结节。这种成像方式被称为光学相干断层扫描自体荧光成像（OCT-AFI），可以成像早期肺癌中肺组织成分和结构特征的变化。本提案的目标是1)进一步发展创新，以提高OCT-AFI的分辨率和对比度2)；使反射和窄带成像通过同一导管；3)进一步缩小导管（<0.5mm），以便进入更小的气道；4)建立定量肺组织特征的方法。这些创新将提高在肺的几乎所有区域定位肺结节的能力。这种新一代内窥镜成像仪器将在小型研究人群中进行测试。研究团队来自不同的背景，在开发临床证明的光学成像设备方面有着丰富的经验，在肺癌的诊断和治疗方面有着丰富的临床研究历史。该研究为早期肺癌的定位提供了一种灵敏、准确的仪器，具有很大的潜力，可以影响临床实践，改善加拿大和世界范围内的患者护理。

In Canada, lung cancer is the leading cause of cancer death accounting for over a quarter ofall cancer deaths in men and women. The National Lung Screening Trial showed that lowdosespiral CT imaging can reduce cancer mortality by 20% in high-risk smokers compared tostandard chest x-ray, primarily by detecting early stage cancer nodules, the majority of whichare small (<9mm) and located in the lung periphery. For definitive lung cancer diagnosis andtreatment planning, a physician must locate and sample suspected lung cancer nodules. Thesafest way to locate and sample lung nodules is using a bronchoscope; however, they are toolarge to access the small peripheral airways. We have recently pioneered a new fiber opticimaging catheter that is 0.9 mm in diameter that shows promise for locating peripheral lungnodules. This imaging modality, called optical coherence tomography autofluorescenceimaging (OCT-AFI) can image changes in the composition and structural features of lungtissue that occur in early lung cancer.The goal of this proposal is 1) to further develop innovations to improve the resolution andcontrast in OCT-AFI 2); to enable reflectance and narrow-band imaging via the samecatheter; 3) to miniaturize the catheters further (<0.5mm) to allow access to even smallerairways; and 4) to develop methods for quantifying lung tissue features. These innovationsshould increase the ability to locate lung nodules in almost all areas of the lungs. This nextgenerationendoscopic imaging instrument will be tested in a small study population.The research team comes from diverse backgrounds with extensive experience developingclinically proven optical imaging devices, and a wealth of clinical research history in thediagnosis and management of lung cancer. This research has great potential to affect clinicalpractice to improve patient care in Canada and worldwide by providing a sensitive andaccurate instrument for locating early lung cancer.