Early Detection and Diagnosis of Lung Cancer with Endomicroscopy

项目总结 肺癌的早期诊断对患者的生存至关重要。不幸的是，绝大多数案件都是 一旦症状出现，癌症扩散，患者治愈希望渺茫(平均5年 存活率为15%)。美国预防服务工作组建议高危人群 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，并降低了这些患者的死亡率， 然而，在检测到的结节中，只有5%可能是癌症。肺癌的诊断必须在 传统上是通过获取组织标本来进行后续组织病理学检查 考试。活组织检查方法一般分为两类：高危外科手术和经胸 提供更高诊断率的程序，以及基于支气管镜检查的低风险程序，通常 有较低的产量。鉴于LDCT筛查发现的绝大多数结节是良性的，因此至关重要 避免了高风险的诊断程序。支气管镜检查的诊断率低 活组织检查可归因于组织不够大、位置不适当或未诊断 取样。因此，迫切需要大幅提高低风险支气管的诊断率。 活组织检查方法。在我们的实验室里，我们开发了新的光学相干层析成像(OCT)成像 提供组织微结构的高分辨率图像的方法。此外，我们还开发了 弥散型OCT诊断肺癌的判读标准。在这项建议中，我们的目标是进一步 开发我们的支气管腔内OCT成像导管，以提供更高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率的目标(目标2)，并使用我们的 内窥镜图像和以前制定的图像解释标准提供了初步的 程序室内病变的诊断(目标3)。术中诊断性内窥镜检查 除了微小的物理图像外，图像可能是为病理学家提供的有用的补充信息 活检标本用于诊断，或使小病变能够立即诊断和治疗，而不需要 需要第二次手术。

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.