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，占男性和女性所有癌症死亡人数的四分之一以上。国家肺筛查试验表明，与标准胸部X光相比，低剂量螺旋CT成像可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，其中大多数是小的（<9mm），位于肺周围。对于明确的肺癌诊断和治疗计划，医生必须定位和采样可疑的肺癌结节。定位和取样肺结节最快的方法是使用支气管镜;然而，支气管镜太大，无法进入小的外周气道。我们最近率先开发了一种直径为0.9 mm的新型光纤成像导管，有望用于定位外周肺结节。该成像模式被称为光学相干断层扫描自体荧光成像（OCT-AFI），可以对早期肺癌中发生的肺组织成分和结构特征的变化进行成像。3）进一步扩大导管（<0.5mm），以允许进入甚至更小的气道; 4）开发量化肺组织特征的方法。这些创新将提高定位几乎所有肺部区域的肺结节的能力。这款新一代内窥镜成像仪器将在一个小规模的研究人群中进行测试。研究团队来自不同的背景，拥有开发临床验证的光学成像设备的丰富经验，以及在肺癌诊断和管理方面的丰富临床研究历史。这项研究有很大的潜力影响临床实践，以改善病人的护理在加拿大和世界各地提供一个敏感和准确的仪器定位早期肺癌。

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.