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Kennedy GT, Azari FS, Chang A, Bou-Samra P, Desphande C, Predina J, Delikatny EJ, Olson M, Rice DC, Singhal S. A Phase 2 Multicenter Clinical Trial of Intraoperative Molecular Imaging of Lung Cancer with a pH-Activatable Nanoprobe. Mol Imaging Biol 2024; 26:585-592. [PMID: 38992245 DOI: 10.1007/s11307-024-01933-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2024] [Revised: 06/29/2024] [Accepted: 07/01/2024] [Indexed: 07/13/2024]
Abstract
PURPOSE Intraoperative molecular imaging (IMI) uses tumor-targeted optical contrast agents to improve identification and clearance of cancer. Recently, a probe has been developed that only fluoresces when activated in an acidic pH, which is common to many malignancies. We report the first multicenter Phase 2 trial of a pH-activatable nanoprobe (pegsitacianine, ONM-100) for IMI of lung cancer. METHODS Patients with suspected or biopsy-confirmed lung cancer scheduled for sublobar resection were administered a single intravenous infusion of pegsitacianine (1 mg/kg) one to three days prior to surgery. Intraoperatively, the patients underwent a white light thoracoscopic evaluation, and then were imaged with an NIR thoracoscope to detect tumor fluorescence. The primary study endpoint was the proportion of patients with a clinically significant event (CSE) which was defined as an intraoperative discovery during IMI that led to a change in the surgical procedure. Possible CSEs included (i) localizing the index lung nodule that could not be located by white light, (ii) identifying a synchronous malignant lesion, or (iii) recognizing a close surgical margin (< = 10 mm). Secondary endpoints were sensitivity, specificity, NPV, and PPV of pegsitacianine in detecting tumor-containing tissue. The safety evaluation was based on adverse event reporting, clinical laboratory parameters, and physical examinations. RESULTS Twenty patients were confirmed as eligible and administered pegsitacianine. Most of the patients were female (n = 12 [60%]), middle-aged (mean age 63.4 years), and former smokers (n = 13 [65%], 28.6 mean pack years). Mean lesion size was 1.9 cm, and most lesions (n = 17 [85%]) were malignant. The most common histologic subtype was adenocarcinoma (n = 9). By utilizing IMI with pegsitacianine, one patient had a CSE in the detection of a close margin and another had localization of a tumor not detectable by traditional surgical means. Six of 19 (31.6%) malignant lesions fluoresced with mean tumor-to-background ratio (TBR) of 3.00, as compared to TBR of 1.20 for benign lesions (n = 3). Sensitivity and specificity of pegsitacianine-based IMI for detecting malignant tissue was 31.6% and 33.3%, respectively. Positive predictive value (PPV) and negative predictive value (NPV) of pegsitacianine-based IMI was 75% and 7.1%, respectively. Pegsitacianine-based imaging was not effective in differentiating benign and malignant lymph nodes. From a safety perspective, no drug-related serious adverse events occurred. Four patients experienced mild pegsitacianine-related infusion reactions which required discontinuing the study drug with complete resolution of symptoms. CONCLUSIONS Pegsitacianine-based IMI, though well tolerated from a safety perspective, does not consistently label lung tumors during resection and does not provide significant clinical benefit over existing standards of surgical care. The biology of lung tumors may not be as acidic as other solid tumors in the body thereby not activating the probe as predicted.
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Affiliation(s)
- Gregory T Kennedy
- Department of Surgery, University of Pennsylvania School of Medicine, 3400 Civic Center Boulevard 14th Floor South Pavilion, Philadelphia, PA, 19104, USA.
| | - Feredun S Azari
- Department of Surgery, University of Pennsylvania School of Medicine, 3400 Civic Center Boulevard 14th Floor South Pavilion, Philadelphia, PA, 19104, USA
| | - Austin Chang
- Department of Surgery, University of Pennsylvania School of Medicine, 3400 Civic Center Boulevard 14th Floor South Pavilion, Philadelphia, PA, 19104, USA
| | - Patrick Bou-Samra
- Department of Surgery, University of Pennsylvania School of Medicine, 3400 Civic Center Boulevard 14th Floor South Pavilion, Philadelphia, PA, 19104, USA
| | - Charuhas Desphande
- Department of Pathology, University of Pennsylvania School of Medicine, Philadelphia, PA, USA
| | - Jarrod Predina
- Department of Surgery, University of Pennsylvania School of Medicine, 3400 Civic Center Boulevard 14th Floor South Pavilion, Philadelphia, PA, 19104, USA
| | - Edward J Delikatny
- Department of Radiology, University of Pennsylvania School of Medicine, Philadelphia, PA, USA
| | | | - David C Rice
- Department of Surgery, MD Anderson Cancer Center, Houston, TX, USA
| | - Sunil Singhal
- Department of Surgery, University of Pennsylvania School of Medicine, 3400 Civic Center Boulevard 14th Floor South Pavilion, Philadelphia, PA, 19104, USA
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Su CC, Zhang ZR, Liu JX, Meng JG, Ma XQ, Mo ZF, Ren JB, Liang ZX, Yang Z, Li CS, Chen LA. Vaporization of perfluorocarbon attenuates sea-water-drowning-induced acute lung injury by deactivating the NLRP3 inflammasomes in canines. Exp Biol Med (Maywood) 2024; 249:10104. [PMID: 38708425 PMCID: PMC11066214 DOI: 10.3389/ebm.2024.10104] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2024] [Accepted: 04/05/2024] [Indexed: 05/07/2024] Open
Abstract
Seawater-drowning-induced acute lung injury (SD-ALI) is a life-threatening disorder characterized by increased alveolar-capillary permeability, an excessive inflammatory response, and refractory hypoxemia. Perfluorocarbons (PFCs) are biocompatible compounds that are chemically and biologically inert and lack toxicity as oxygen carriers, which could reduce lung injury in vitro and in vivo. The aim of our study was to explore whether the vaporization of PFCs could reduce the severity of SD-ALI in canines and investigate the underlying mechanisms. Eighteen beagle dogs were randomly divided into three groups: the seawater drowning (SW), perfluorocarbon (PFC), and control groups. The dogs in the SW group were intratracheally administered seawater to establish the animal model. The dogs in the PFC group were treated with vaporized PFCs. Probe-based confocal laser endomicroscopy (pCLE) was performed at 3 h. The blood gas, volume air index (VAI), pathological changes, and wet-to-dry (W/D) lung tissue ratios were assessed. The expression of heme oxygenase-1 (HO-1), nuclear respiratory factor-1 (NRF1), and NOD-like receptor family pyrin domain containing-3 (NLRP3) inflammasomes was determined by means of quantitative real-time polymerase chain reaction (qRT-PCR) and immunological histological chemistry. The SW group showed higher lung injury scores and W/D ratios, and lower VAI compared to the control group, and treatment with PFCs could reverse the change of lung injury score, W/D ratio and VAI. PFCs deactivated NLRP3 inflammasomes and reduced the release of caspase-1, interleukin-1β (IL-1β), and interleukin-18 (IL-18) by enhancing the expression of HO-1 and NRF1. Our results suggest that the vaporization of PFCs could attenuate SD-ALI by deactivating NLRP3 inflammasomes via the HO-1/NRF1 pathway.
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Affiliation(s)
- Cheng-Cheng Su
- Medical School of Chinese PLA, Beijing, China
- Department of Respiration, The Eight Medical Center of Chinese PLA General Hospital, Beijing, China
- Department of Critical Care and Respiration, Characteristic Medical Center of Chinese People’s Armed Police Force, Tianjin, China
| | - Zhao-Rui Zhang
- Department of Respiration, The Eight Medical Center of Chinese PLA General Hospital, Beijing, China
| | - Jin-Xia Liu
- Medical School of Chinese PLA, Beijing, China
- Department of Respiration, The Eight Medical Center of Chinese PLA General Hospital, Beijing, China
| | - Ji-Guang Meng
- Department of Respiration, The Eight Medical Center of Chinese PLA General Hospital, Beijing, China
| | - Xiu-Qing Ma
- Department of Respiration, The Eight Medical Center of Chinese PLA General Hospital, Beijing, China
| | - Zhen-Fei Mo
- Medical School of Chinese PLA, Beijing, China
- Department of Respiration, The Eight Medical Center of Chinese PLA General Hospital, Beijing, China
| | - Jia-Bo Ren
- Medical School of Chinese PLA, Beijing, China
- Department of Respiration, The Eight Medical Center of Chinese PLA General Hospital, Beijing, China
| | - Zhi-Xin Liang
- Department of Respiration, The Eight Medical Center of Chinese PLA General Hospital, Beijing, China
| | - Zhen Yang
- Department of Respiration, The Eight Medical Center of Chinese PLA General Hospital, Beijing, China
| | - Chun-Sun Li
- Department of Respiration, The Eight Medical Center of Chinese PLA General Hospital, Beijing, China
| | - Liang-An Chen
- Department of Respiration, The Eight Medical Center of Chinese PLA General Hospital, Beijing, China
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Bonhomme O, Heinen V, Louis R, Corhay JL, Duysinx B. [Probe based confocal laser endomicroscopy in thoracic endoscopy]. Rev Mal Respir 2024; 41:145-155. [PMID: 38030554 DOI: 10.1016/j.rmr.2023.11.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2023] [Accepted: 10/10/2023] [Indexed: 12/01/2023]
Abstract
INTRODUCTION Probe based confocal laser endomicroscopy (pCLE) is a new endoscopic imaging technology. It uses mini probes which can be introduced through the working channels of endoscopes. Whenever applied on the tissue of interest, they allow imaging of tissue at a cellular level. STATE OF ART In the filed of pleuropulmonary malignancies, pCLE showed mostly its ability to guide biopsies samplings. Those results need to be validated in larger prospective studies. In interstitial lung diseases, pCLE provides information complementary to other clinical and paraclinical data. The valuability of these informations need to be investigated further, prospectively in randomized trials. In obstructive pulmonary diseases, pCLE is able to investigate the structural and functional relationships between pulmonary structures. pCLE showed good ability in the identification of acute cellular rejection after lung transplantation. PERSPECTIVES AND CONCLUSION For the time being, pCLE is not part of routine clinical practice. The data available need to be validated in larger randomized prospective trials, before it can be recommended as a guiding tool for biopsies or as a diagnostic tool for pathologic process. New fluorophores are now available. They are specific of some molecular sequences, allowing the enhancement of specific targets within the sample studied.
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Affiliation(s)
- O Bonhomme
- Pneumologues, CHU de Liège, 4000 Liège, Belgique.
| | - V Heinen
- Pneumologues, CHU de Liège, 4000 Liège, Belgique
| | - R Louis
- Pneumologues, CHU de Liège, 4000 Liège, Belgique
| | - J-L Corhay
- Pneumologues, CHU de Liège, 4000 Liège, Belgique
| | - B Duysinx
- Pneumologues, CHU de Liège, 4000 Liège, Belgique
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Wu J, Liang B, Lu S, Xie J, Song Y, Wang L, Gao L, Huang Z. Application of 3D printing technology in tumor diagnosis and treatment. Biomed Mater 2023; 19:012002. [PMID: 37918002 DOI: 10.1088/1748-605x/ad08e1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2023] [Accepted: 11/01/2023] [Indexed: 11/04/2023]
Abstract
3D printing technology is an increasing approach consisting of material manufacturing through the selective incremental delamination of materials to form a 3D structure to produce products. This technology has different advantages, including low cost, short time, diversification, and high precision. Widely adopted additive manufacturing technologies enable the creation of diagnostic tools and expand treatment options. Coupled with its rapid deployment, 3D printing is endowed with high customizability that enables users to build prototypes in shorts amounts of time which translates into faster adoption in the medical field. This review mainly summarizes the application of 3D printing technology in the diagnosis and treatment of cancer, including the challenges and the prospects combined with other technologies applied to the medical field.
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Affiliation(s)
- Jinmei Wu
- School of Artificial Intelligence and Information Technology, Nanjing University of Chinese Medicine, No. 138 Xianling Rd., Nanjing 210023, Jiangsu, People's Republic of China
- School of Chemistry and Chemical Engineering, Guangxi Minzu University, No.158, University West Road, Nanning 530000, Guangxi, People's Republic of China
| | - Bing Liang
- School of Artificial Intelligence and Information Technology, Nanjing University of Chinese Medicine, No. 138 Xianling Rd., Nanjing 210023, Jiangsu, People's Republic of China
- School of Chemistry and Chemical Engineering, Guangxi Minzu University, No.158, University West Road, Nanning 530000, Guangxi, People's Republic of China
| | - Shuoqiao Lu
- School of Chemistry and Chemical Engineering, Guangxi Minzu University, No.158, University West Road, Nanning 530000, Guangxi, People's Republic of China
| | - Jinlan Xie
- School of Chemistry and Chemical Engineering, Guangxi Minzu University, No.158, University West Road, Nanning 530000, Guangxi, People's Republic of China
| | - Yan Song
- China Automotive Engineering Research Institute Co., Ltd (CAERI), Chongqing 401122, People's Republic of China
| | - Lude Wang
- School of Artificial Intelligence and Information Technology, Nanjing University of Chinese Medicine, No. 138 Xianling Rd., Nanjing 210023, Jiangsu, People's Republic of China
| | - Lingfeng Gao
- College of Material, Chemistry and Chemical Engineering, Key Laboratory of Organosilicon Chemistry and Material Technology, Ministry of Education, Hangzhou Normal University, Hangzhou 311121, Zhejiang, People's Republic of China
| | - Zaiyin Huang
- School of Chemistry and Chemical Engineering, Guangxi Minzu University, No.158, University West Road, Nanning 530000, Guangxi, People's Republic of China
- College of Material, Chemistry and Chemical Engineering, Key Laboratory of Organosilicon Chemistry and Material Technology, Ministry of Education, Hangzhou Normal University, Hangzhou 311121, Zhejiang, People's Republic of China
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Kennedy GT, Azari FS, Chang A, Chang A, Bou-Samra P, Desphande C, Delikatny EJ, Eruslanov E, Kucharczuk JC, Rice DC, Singhal S. A pH-Activatable Nanoprobe Labels Diverse Histologic Subtypes of Human Lung Cancer During Resection. Mol Imaging Biol 2023; 25:824-832. [PMID: 37697109 PMCID: PMC11141135 DOI: 10.1007/s11307-023-01853-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2023] [Revised: 08/02/2023] [Accepted: 08/15/2023] [Indexed: 09/13/2023]
Abstract
BACKGROUND Intraoperative molecular imaging (IMI) uses tumor-targeted optical contrast agents to improve identification and clearance of cancer during surgery. Recently, pH-activatable contrast agents have been developed but none has been tested in lung cancer. Here, we report the successful clinical translation of pegsitacianine (ONM-100), a pH-activatable nanoprobe, for fluorescence-guided lung cancer resection. METHODS We first characterized the pH setpoint for pegsitacianine fluorescence activation in vitro. We then optimized the specificity, dosing, and timing of pegsitacianine in murine flank xenograft models of lung adenocarcinoma and squamous cell carcinoma. Finally, we tested pegsitacianine in humans undergoing lung cancer surgery as part of an ongoing phase 2 trial. RESULTS We found that the fluorescence activation of pegsitacianine occurred below physiologic pH in vitro. Using preclinical models of lung cancer, we found that the probe selectively labeled both adenocarcinoma and squamous cell carcinoma xenografts (mean tumor-to-background ratio [TBR] > 2.0 for all cell lines). In the human pilot study, we report cases in which pegsitacianine localized pulmonary adenocarcinoma and pulmonary squamous cell carcinoma (TBRs= 2.7 and 2.4) in real time to illustrate its successful clinical translation and potential to improve surgical management. CONCLUSIONS This translational study demonstrates the feasibility of pegsitacianine as an IMI probe to label the two most common histologic subtypes of human lung cancer.
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Affiliation(s)
- Gregory Thomas Kennedy
- Department of Surgery, University of Pennsylvania School of Medicine, 3400 Civic Center Boulevard, 14th Floor, South Pavilion, Philadelphia, PA, 19104, USA
| | - Feredun S Azari
- Department of Surgery, University of Pennsylvania School of Medicine, 3400 Civic Center Boulevard, 14th Floor, South Pavilion, Philadelphia, PA, 19104, USA
| | - Ashley Chang
- Department of Surgery, University of Pennsylvania School of Medicine, 3400 Civic Center Boulevard, 14th Floor, South Pavilion, Philadelphia, PA, 19104, USA
| | - Austin Chang
- Department of Surgery, University of Pennsylvania School of Medicine, 3400 Civic Center Boulevard, 14th Floor, South Pavilion, Philadelphia, PA, 19104, USA
| | - Patrick Bou-Samra
- Department of Surgery, University of Pennsylvania School of Medicine, 3400 Civic Center Boulevard, 14th Floor, South Pavilion, Philadelphia, PA, 19104, USA
| | - Charuhas Desphande
- Department of Pathology, University of Pennsylvania School of Medicine, Philadelphia, PA, USA
| | - Edward J Delikatny
- Department of Radiology, University of Pennsylvania School of Medicine, Philadelphia, PA, USA
| | - Evgeniy Eruslanov
- Department of Surgery, University of Pennsylvania School of Medicine, 3400 Civic Center Boulevard, 14th Floor, South Pavilion, Philadelphia, PA, 19104, USA
| | - John C Kucharczuk
- Department of Surgery, University of Pennsylvania School of Medicine, 3400 Civic Center Boulevard, 14th Floor, South Pavilion, Philadelphia, PA, 19104, USA
| | - David C Rice
- Department of Surgery, MD Anderson Cancer Center, Houston, TX, USA
| | - Sunil Singhal
- Department of Surgery, University of Pennsylvania School of Medicine, 3400 Civic Center Boulevard, 14th Floor, South Pavilion, Philadelphia, PA, 19104, USA.
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Olszowy M, Nowak-Perlak M, Woźniak M. Current Strategies in Photodynamic Therapy (PDT) and Photodynamic Diagnostics (PDD) and the Future Potential of Nanotechnology in Cancer Treatment. Pharmaceutics 2023; 15:1712. [PMID: 37376160 DOI: 10.3390/pharmaceutics15061712] [Citation(s) in RCA: 7] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2023] [Revised: 06/03/2023] [Accepted: 06/08/2023] [Indexed: 06/29/2023] Open
Abstract
Photodynamic diagnostics (PDD) and photodynamic therapy (PDT) are well-established medical technologies used for the diagnosis and treatment of malignant neoplasms. They rely on the use of photosensitizers, light and oxygen to visualize or eliminate cancer cells. This review demonstrates the recent advancements in these modalities with the use of nanotechnology, including quantum dots as innovative photosensitizers or energy donors, liposomes and micelles. Additionally, this literature review explores the combination of PDT with radiotherapy, chemotherapy, immunotherapy, and surgery for treating various neoplasms. The article also focuses on the latest achievements in PDD and PDT enhancements, which seem to be very promising in the field of oncology.
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Affiliation(s)
- Marta Olszowy
- Department of Clinical and Experimental Pathology, Division of General and Experimental Pathology, Wroclaw Medical University, 50-368 Wroclaw, Poland
| | - Martyna Nowak-Perlak
- Department of Clinical and Experimental Pathology, Division of General and Experimental Pathology, Wroclaw Medical University, 50-368 Wroclaw, Poland
| | - Marta Woźniak
- Department of Clinical and Experimental Pathology, Division of General and Experimental Pathology, Wroclaw Medical University, 50-368 Wroclaw, Poland
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Tian S, Huang H, Zhang Y, Shi H, Dong Y, Zhang W, Bai C. The role of confocal laser endomicroscopy in pulmonary medicine. Eur Respir Rev 2023; 32:32/167/220185. [PMID: 36697210 PMCID: PMC9879334 DOI: 10.1183/16000617.0185-2022] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2022] [Accepted: 11/21/2022] [Indexed: 01/26/2023] Open
Abstract
Accurate diagnosis and subsequent therapeutic options in pulmonary diseases mainly rely on imaging methods and histological assessment. However, imaging examinations are hampered by the limited spatial resolution of images and most procedures that are related to histological assessment are invasive with associated complications. As a result, a high-resolution imaging technology - confocal laser endomicroscopy (CLE), which is at the forefront and enables real-time microscopic visualisation of the morphologies and architectures of tissues or cells - has been developed to resolve the clinical dilemma pertaining to current techniques. The current evidence has shown that CLE has the potential to facilitate advanced diagnostic capabilities, to monitor and to aid the tailored treatment regime for patients with pulmonary diseases, as well as to expand the horizon for unravelling the mechanism and therapeutic targets of pulmonary diseases. In the future, if CLE can be combined with artificial intelligence, early, rapid and accurate diagnosis will be achieved through identifying the images automatically. As promising as this technique may be, further investigations are required before it can enter routine clinical practice.
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Affiliation(s)
- Sen Tian
- Department of Respiratory and Critical Care Medicine, The First Affiliated Hospital of Naval Medical University, Shanghai, China,These authors contributed equally to this work
| | - Haidong Huang
- Department of Respiratory and Critical Care Medicine, The First Affiliated Hospital of Naval Medical University, Shanghai, China,These authors contributed equally to this work
| | - Yifei Zhang
- Department of Respiratory and Critical Care Medicine, The First Affiliated Hospital of Naval Medical University, Shanghai, China,Department of Biomedical Engineering, University of Shanghai for Science and Technology, Shanghai, China,These authors contributed equally to this work
| | - Hui Shi
- Department of Respiratory and Critical Care Medicine, The First Affiliated Hospital of Naval Medical University, Shanghai, China
| | - Yuchao Dong
- Department of Respiratory and Critical Care Medicine, The First Affiliated Hospital of Naval Medical University, Shanghai, China
| | - Wei Zhang
- Department of Respiratory and Critical Care Medicine, The First Affiliated Hospital of Naval Medical University, Shanghai, China
| | - Chong Bai
- Department of Respiratory and Critical Care Medicine, The First Affiliated Hospital of Naval Medical University, Shanghai, China,Department of Biomedical Engineering, University of Shanghai for Science and Technology, Shanghai, China,Corresponding author: Chong Bai ()
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Advances in bronchoscopic optical coherence tomography and confocal laser endomicroscopy in pulmonary diseases. Curr Opin Pulm Med 2023; 29:11-20. [PMID: 36474462 PMCID: PMC9780043 DOI: 10.1097/mcp.0000000000000929] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
PURPOSE OF REVIEW Imaging techniques play a crucial role in the diagnostic work-up of pulmonary diseases but generally lack detailed information on a microscopic level. Optical coherence tomography (OCT) and confocal laser endomicroscopy (CLE) are imaging techniques which provide microscopic images in vivo during bronchoscopy. The purpose of this review is to describe recent advancements in the use of bronchoscopic OCT- and CLE-imaging in pulmonary medicine. RECENT FINDINGS In recent years, OCT- and CLE-imaging have been evaluated in a wide variety of pulmonary diseases and demonstrated to be complementary to bronchoscopy for real-time, near-histological imaging. Several pulmonary compartments were visualized and characteristic patterns for disease were identified. In thoracic malignancy, OCT- and CLE-imaging can provide characterization of malignant tissue with the ability to identify the optimal sampling area. In interstitial lung disease (ILD), fibrotic patterns were detected by both (PS-) OCT and CLE, complementary to current HRCT-imaging. For obstructive lung diseases, (PS-) OCT enables to detect airway wall structures and remodelling, including changes in the airway smooth muscle and extracellular matrix. SUMMARY Bronchoscopic OCT- and CLE-imaging allow high resolution imaging of airways, lung parenchyma, pleura, lung tumours and mediastinal lymph nodes. Although investigational at the moment, promising clinical applications are on the horizon.
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Manley CJ, Kramer T, Kumar R, Gong Y, Ehya H, Ross E, Bonta PI, Annema JT. Robotic bronchoscopic needle-based confocal laser endomicroscopy to diagnose peripheral lung nodules. Respirology 2022; 28:475-483. [PMID: 36535801 DOI: 10.1111/resp.14438] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2022] [Accepted: 12/05/2022] [Indexed: 12/24/2022]
Abstract
BACKGROUND AND OBJECTIVE Robotic bronchoscopy has demonstrated high navigational success in small peripheral lung nodules but the diagnostic yield is discrepantly lower. Needle based confocal laser endomicroscopy (nCLE) enables real-time microscopic imaging at the needle tip. We aim to assess feasibility, safety and needle repositioning based on real-time nCLE-guidance during robotic bronchoscopy in small peripheral lung nodules. METHODS Patients with suspected peripheral lung cancer underwent fluoroscopy and radial EBUS assisted robotic bronchoscopy. After radial EBUS nodule identification, nCLE-imaging of the target area was performed. nCLE-malignancy and airway/lung parenchyma criteria were used to identify the optimal sampling location. In case airway was visualized, repositioning of the biopsy needle was performed. After nCLE tool-in-nodule confirmation, needle passes and biopsies were performed at the same location. MEASUREMENTS AND MAIN RESULTS Twenty patients were included (final diagnosis n = 17 (lung) cancer) with a median lung nodule size of 14.5 mm (range 8-28 mm). No complications occurred. In 19/20 patients, good quality nCLE-videos were obtained. In 9 patients (45%), real-time nCLE-imaging revealed inadequate positioning of the needle and repositioning was performed. After repositioning, nCLE-imaging provided tool-in-nodule-confirmation in 19/20 patients. Subsequent ROSE demonstrated representative material in 9/20 patients (45%) and overall diagnostic yield was 80% (16/20). Of the three patients with malignant nCLE-imaging but inadequate pathology, two were diagnosed with malignancy during follow-up. CONCLUSION Robotic bronchoscopic nCLE-imaging is feasible and safe. nCLE-imaging in small, difficult-to-access lung nodules provided additional real-time feedback on the correct needle positioning with the potential to optimize the sampling location and diagnostic yield.
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Affiliation(s)
- Christopher J Manley
- Department of Pulmonary and Critical Care, Fox Chase Cancer Center, Philadelphia, Pennsylvania, USA
| | - Tess Kramer
- Department of Respiratory Medicine, Amsterdam UMC, Amsterdam, Netherlands
| | - Rohit Kumar
- Department of Pulmonary and Critical Care, Fox Chase Cancer Center, Philadelphia, Pennsylvania, USA
| | - Yulan Gong
- Department of Pathology, Fox Chase Cancer Center, Philadelphia, Pennsylvania, USA
| | - Hormoz Ehya
- Department of Pathology, Fox Chase Cancer Center, Philadelphia, Pennsylvania, USA
| | - Eric Ross
- Department of Biostatistics and Bioinformatics, Fox Chase Cancer Center, Philadelphia, Pennsylvania, USA
| | - Peter I Bonta
- Department of Respiratory Medicine, Amsterdam UMC, Amsterdam, Netherlands
| | - Jouke T Annema
- Department of Respiratory Medicine, Amsterdam UMC, Amsterdam, Netherlands
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Shining new light on lung cancer diagnosis using a pafolacianine molecular tracer. Eur J Nucl Med Mol Imaging 2022; 49:3979-3980. [PMID: 35947177 DOI: 10.1007/s00259-022-05929-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2022] [Accepted: 08/04/2022] [Indexed: 11/04/2022]
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