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Zong K, Liu B, Li S, Li Y, Guo S. Endobronchial optical coherence tomography helps to estimate the cartilage damage of the central airway in TBTB patients. Front Cell Infect Microbiol 2023; 13:1278281. [PMID: 38099218 PMCID: PMC10720589 DOI: 10.3389/fcimb.2023.1278281] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2023] [Accepted: 11/10/2023] [Indexed: 12/17/2023] Open
Abstract
Purpose At present, there are few examination methods used to evaluate tracheobronchial cartilage damage. In our study, we explored whether endobronchial optical coherence tomography (EB-OCT) can be used to estimate central airway cartilage damage in tracheobronchial tuberculosis (TBTB) patients. Methods In our study, we used the OCTICS Imaging system to perform EB-OCT scanning for TBTB patients. The thickness of the central airway wall and cartilage was measured by the OCTICS software system workstation. Results There were 102 TBTB patients included in our study cohort. Their EB-OCT images of the central airway cartilage showed that abnormal cartilage manifests as thinning of the cartilage, cartilage damage, cartilage destruction, and even cartilage deficiency. The cartilage morphology becomes irregular and discontinuous. Some parts of the cartilage become brighter in grayscale. The intima of the cartilage is thickened and discontinuous, and the boundary with submucosa and mucosa is unclear. Conclusion Our study conducted EB-OCT examination of the central airway cartilage of TBTB patients in vivo for the first time. EB-OCT helps to estimate the cartilage damage of the central airway in TBTB patients to some extent.
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Affiliation(s)
- Kaican Zong
- Department of Respiratory Medicine, The First Affiliated Hospital, Chongqing Medical University, Chongqing, China
- Department of Respiratory Medicine, The Central Hospital Affiliated Chongqing University of Technology, Chongqing, China
| | - Bin Liu
- Department of Respiratory Medicine, The First Affiliated Hospital, Chongqing Medical University, Chongqing, China
| | - Shiying Li
- Department of Infectious Diseases, Key Laboratory of Molecular Biology for Infectious Diseases (Ministry of Education), Institute for Viral Hepatitis, The Second Affiliated Hospital, Chongqing Medical University, Chongqing, China
| | - Yishi Li
- Department of Respiratory Medicine, The First Affiliated Hospital, Chongqing Medical University, Chongqing, China
| | - Shuliang Guo
- Department of Respiratory Medicine, The First Affiliated Hospital, Chongqing Medical University, Chongqing, China
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Long H, Ji J, Chen L, Feng J, Liao J, Yang Y. EB-OCT: a potential strategy on early diagnosis and treatment for lung cancer. Front Oncol 2023; 13:1156218. [PMID: 37182131 PMCID: PMC10168178 DOI: 10.3389/fonc.2023.1156218] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2023] [Accepted: 04/12/2023] [Indexed: 05/16/2023] Open
Abstract
Lung cancer is the leading cause of cancer-related death in China and the world, mainly attributed to delayed diagnosis, given that currently available early screening strategies exhibit limited value. Endobronchial optical coherence tomography (EB-OCT) has the characteristics of non-invasiveness, accuracy, and repeatability. Importantly, the combination of EB-OCT with existing technologies represents a potential approach for early screening and diagnosis. In this review, we introduce the structure and strengths of EB-OCT. Furthermore, we provide a comprehensive overview of the application of EB-OCT on early screening and diagnosis of lung cancer from in vivo experiments to clinical studies, including differential diagnosis of airway lesions, early screening for lung cancer, lung nodules, lymph node biopsy and localization and palliative treatment of lung cancer. Moreover, the bottlenecks and difficulties in developing and popularizing EB-OCT for diagnosis and treatment during clinical practice are analyzed. The characteristics of OCT images of normal and cancerous lung tissues were in good agreement with the results of pathology, which could be used to judge the nature of lung lesions in real time. In addition, EB-OCT can be used as an assistant to biopsy of pulmonary nodules and improve the success rate of biopsy. EB-OCT also plays an auxiliary role in the treatment of lung cancer. In conclusion, EB-OCT is non-invasive, safe and accurate in real-time. It is of great significance in the diagnosis of lung cancer and suitable for clinical application and is expected to become an important diagnostic method for lung cancer in the future.
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Affiliation(s)
- Hang Long
- Department of Respiratory and Critical Medicine, Sichuan Provincial People’s Hospital, Sichuan Academy of Medical Sciences, Chengdu, Sichuan, China
| | - Jiaqi Ji
- Department of Respiratory and Critical Medicine, Sichuan Provincial People’s Hospital, Sichuan Academy of Medical Sciences, Chengdu, Sichuan, China
| | - Lijuan Chen
- Department of Respiratory and Critical Medicine, Sichuan Provincial People’s Hospital, Sichuan Academy of Medical Sciences, Chengdu, Sichuan, China
| | - Jiayue Feng
- Department of Cardiology, Sichuan Provincial People’s Hospital, Sichuan Academy of Medical Sciences, Chengdu, Sichuan, China
| | - Jie Liao
- Department of Cardiology, Sichuan Provincial People’s Hospital, Sichuan Academy of Medical Sciences, Chengdu, Sichuan, China
| | - Yang Yang
- Department of Respiratory and Critical Medicine, Sichuan Provincial People’s Hospital, Sichuan Academy of Medical Sciences, Chengdu, Sichuan, China
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Zhu Q, Yu H, Liang Z, Zhao W, Zhu M, Xu Y, Guo M, Jia Y, Zou C, Yang Z, Chen L. Novel image features of optical coherence tomography for pathological classification of lung cancer: Results from a prospective clinical trial. Front Oncol 2022; 12:870556. [PMID: 36338729 PMCID: PMC9634220 DOI: 10.3389/fonc.2022.870556] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2022] [Accepted: 09/27/2022] [Indexed: 12/24/2022] Open
Abstract
Background This study aimed to explore the characteristics of optical coherence tomography (OCT) imaging for differentiating between benign and malignant lesions and different pathological types of lung cancer in bronchial lesions and to preliminarily evaluate the clinical value of OCT. Methods Patients who underwent bronchoscopy biopsy and OCT between February 2019 and December 2019 at the Chinese PLA General Hospital were enrolled in this study. White-light bronchoscopy (WLB), auto-fluorescence bronchoscopy (AFB), and OCT were performed at the lesion location. The main characteristics of OCT imaging for the differentiation between benign and malignant lesions and the prediction of the pathological classification of lung cancer in bronchial lesions were identified, and their clinical value was evaluated. Results A total of 135 patients were included in this study. The accuracy of OCT imaging for differentiating between benign and malignant bronchial lesions was 94.1%, which was significantly higher than that of AFB (67.4%). For the OCT imaging of SCC, adenocarcinoma, and small-cell lung cancer, the accuracies were 95.6, 94.3, and 92%, respectively. The accuracy, sensitivity, and specificity of OCT were higher than those of WLB. In addition, these main OCT image characteristics are independent influencing factors for predicting the corresponding diseases through logistic regression analysis between the main OCT image characteristics in the study and the general clinical features of patients (p<0.05). Conclusion As a non-biopsy technique, OCT can be used to improve the diagnosis rate of lung cancer and promote the development of non-invasive histological biopsy.
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Affiliation(s)
- Qiang Zhu
- Department of Respiratory Medicine, The First Medical Center of Chinese People Liberation Army (PLA) General Hospital, Beijing, China
| | - Hang Yu
- Department of Respiratory Medicine, The First Medical Center of Chinese People Liberation Army (PLA) General Hospital, Beijing, China
| | - Zhixin Liang
- Department of Respiratory Medicine, The First Medical Center of Chinese People Liberation Army (PLA) General Hospital, Beijing, China
| | - Wei Zhao
- Department of Respiratory Medicine, The First Medical Center of Chinese People Liberation Army (PLA) General Hospital, Beijing, China
| | - Minghui Zhu
- Department of Pulmonary and Critical Care Medicine, Zhongnan Hospital of Wuhan University, Wuhan, China
| | - Yi Xu
- Department of Respiratory Medicine, The First Medical Center of Chinese People Liberation Army (PLA) General Hospital, Beijing, China
| | - Mingxue Guo
- Department of Respiratory Medicine, The First Medical Center of Chinese People Liberation Army (PLA) General Hospital, Beijing, China
| | - Yanhong Jia
- Department of Respiratory Medicine, The First Medical Center of Chinese People Liberation Army (PLA) General Hospital, Beijing, China
| | - Chenxi Zou
- Department of Respiratory Medicine, The First Medical Center of Chinese People Liberation Army (PLA) General Hospital, Beijing, China
| | - Zhen Yang
- Department of Respiratory Medicine, The First Medical Center of Chinese People Liberation Army (PLA) General Hospital, Beijing, China
- *Correspondence: Zhen Yang, ; Liangan Chen,
| | - Liangan Chen
- Department of Respiratory Medicine, The First Medical Center of Chinese People Liberation Army (PLA) General Hospital, Beijing, China
- *Correspondence: Zhen Yang, ; Liangan Chen,
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Sun XM, Luo JQ, Xiao ZW, Gu QY, Lan LC, Zhang HQ, Zhang GP. Investigations on the potential of optical coherence tomography as an imaging tool for eustachian tube. Sci Rep 2021; 11:8072. [PMID: 33850252 PMCID: PMC8044113 DOI: 10.1038/s41598-021-87637-6] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2020] [Accepted: 04/01/2021] [Indexed: 11/09/2022] Open
Abstract
The purpose of this study was to explore the feasibility of eustachian tube optical coherence tomography (ET-OCT) for imaging the pharyngeal region of the eustachian tube (ET). Ten subjects with ear complaints underwent ET-OCT guided by nasal endoscopy, and ET-OCT examination was performed on both sides of each subject's ETs. The process and resulting images were analysed. Ten subjects ranging from 21 to 73 years old (45 ± 14.77) were enrolled in this study. Eighteen ET-OCT imaging examinations were completed. The mean duration of each examination was 2.80 ± 1.62 min (ranging from 2 to 7 min). There were no adverse events or complications. In some subjects, the ET-OCT images clearly presented the microstructures of the ET wall, including the lumen, mucosa, submucosa, cartilage and plica. However, in some subjects, it showed different characteristics, such as an unclear hierarchy and secretions in the lumen. ET-OCT may help to distinguish the structural composition of the ET and elucidate related pathophysiological mechanisms. It is a valuable imaging tool suited for the ET, with potential diagnostic value in determining the morphology of the lumen, intraluminal mucosa and submucosal tissue in the pharyngeal region of the ET.
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Affiliation(s)
- Xiao-Mei Sun
- Department of Otolaryngology Head and Neck Surgery, The Sixth Affiliated Hospital of Sun Yat-Sen University, Guangzhou, 510655, China
| | - Jia-Qi Luo
- Department of Otolaryngology Head and Neck Surgery, The Sixth Affiliated Hospital of Sun Yat-Sen University, Guangzhou, 510655, China
| | - Zhi-Wen Xiao
- Department of Otolaryngology Head and Neck Surgery, The Sixth Affiliated Hospital of Sun Yat-Sen University, Guangzhou, 510655, China
| | - Qing-Yu Gu
- Department of Otolaryngology Head and Neck Surgery, The Sixth Affiliated Hospital of Sun Yat-Sen University, Guangzhou, 510655, China
| | - Lin-Chan Lan
- Department of Otolaryngology Head and Neck Surgery, The Sixth Affiliated Hospital of Sun Yat-Sen University, Guangzhou, 510655, China
| | - Hui-Qing Zhang
- Department of Otolaryngology Head and Neck Surgery, The Sixth Affiliated Hospital of Sun Yat-Sen University, Guangzhou, 510655, China
| | - Guan-Ping Zhang
- Department of Otolaryngology Head and Neck Surgery, The Sixth Affiliated Hospital of Sun Yat-Sen University, Guangzhou, 510655, China.
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Zhou ZQ, Su ZQ, Sun W, Zhong ML, Chen Y, Zhong CH, Chen HJ, Li SY. Postintubation Tracheal Stenosis Evaluated by Endobronchial Optical Coherence Tomography: A Canine Model Study. Respiration 2020; 99:500-507. [DOI: 10.1159/000506882] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2019] [Accepted: 02/27/2020] [Indexed: 11/19/2022] Open
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Abstract
INTRODUCTION The field of interventional pulmonology (IP) is a rapidly maturing subspecialty of pulmonary medicine, which emphasizes advanced diagnostic and therapeutic bronchoscopy for the evaluation and management of central airway obstruction, mediastinal/hilar adenopathy and lung nodules/masses, as well as minimally invasive diagnostic and therapeutic pleural procedures. Areas covered: This review describes advances in diagnostic and therapeutic bronchoscopic techniques. Expert commentary: In the past decade, there has been a remarkable growth in available technology and equipment, as well as clinical and translational research efforts focused on patient-centered outcomes. Furthermore, the recent establishment of a uniform accreditation standard for all IP fellowship programs in the United States was an important step in the continued evolution of this subspecialty of pulmonary medicine.
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Affiliation(s)
- Diana H Yu
- a School of Medicine, Division of Pulmonary/Critical Care Medicine, Section of Interventional Pulmonology , Johns Hopkins University , Baltimore , USA
| | - David Feller-Kopman
- a School of Medicine, Division of Pulmonary/Critical Care Medicine, Section of Interventional Pulmonology , Johns Hopkins University , Baltimore , USA
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Ling Y, Yao X, Gamm UA, Arteaga-Solis E, Emala CW, Choma MA, Hendon CP. Ex vivo visualization of human ciliated epithelium and quantitative analysis of induced flow dynamics by using optical coherence tomography. Lasers Surg Med 2017; 49:270-279. [PMID: 28231402 DOI: 10.1002/lsm.22653] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/08/2017] [Indexed: 12/12/2022]
Abstract
BACKGROUND AND OBJECTIVE Cilia-driven mucociliary clearance is an important self-defense mechanism of great clinical importance in pulmonary research. Conventional light microscopy possesses the capability to visualize individual cilia and its beating pattern but lacks the throughput to assess the global ciliary activities and flow dynamics. Optical coherence tomography (OCT), which provides depth-resolved cross-sectional images, was recently introduced to this area. MATERIALS AND METHODS Fourteen de-identified human tracheobronchial tissues are directly imaged by two OCT systems: one system centered at 1,300 nm with 6.5 μm axial resolution and 15 μm lateral resolution, and the other centered at 800 nm with 2.72 μm axial resolution and 5.52 μm lateral resolution. Speckle variance images are obtained in both cross-sectional and volumetric modes. After imaging, sample blocks are sliced along the registered OCT imaging plane and processed with hematoxylin and eosin (H&E) stain for comparison. Quantitative flow analysis is performed by tracking the path-lines of microspheres in a fixed cross-section. Both the flow rate and flow direction are characterized. RESULTS The speckle variance images successfully segment the ciliated epithelial tissue from its cilia-denuded counterpart, and the results are validated by corresponding H&E stained sections. A further temporal frequency analysis is performed to extract the ciliary beat frequency (CBF) at cilia cites. By adding polyester microspheres as contrast agents, we demonstrate ex vivo imaging of the flow induced by cilia activities of human tracheobronchial samples. CONCLUSION This manuscript presents an ex vivo study on human tracheobronchial ciliated epithelium and its induced mucous flow by using OCT. Within OCT images, intact ciliated epithelium is effectively distinguished from cilia-denuded counterpart, which serves as a negative control, by examining the speckle variance images. The cilia beat frequency is extracted by temporal frequency analysis. The flow rate, flow direction, and particle throughput are obtained through particle tracking. The availability of these quantitative parameters provides us with a powerful tool that will be useful for studying the physiology, pathophysiology and the effectiveness of therapies on epithelial cilia function, as well as serve as a diagnostic tool for diseases associated with ciliary dysmotility. Lasers Surg. Med. 49:270-279, 2017. © 2017 Wiley Periodicals, Inc.
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Affiliation(s)
- Yuye Ling
- Department of Electrical Engineering, Columbia University, New York, New York
| | - Xinwen Yao
- Department of Electrical Engineering, Columbia University, New York, New York
| | - Ute A Gamm
- Department of Radiology & Biomedical Imaging, Yale University, New Haven, Connecticut
| | - Emilio Arteaga-Solis
- Division of Pediatric Pulmonary, Department of Pediatrics, College of Physicians and Surgeons, Columbia University, New York, New York
| | - Charles W Emala
- Department of Anesthesiology, College of Physicians and Surgeons, Columbia University, New York, New York
| | - Michael A Choma
- Department of Radiology & Biomedical Imaging, Yale University, New Haven, Connecticut.,Department of Biomedical Engineering, Yale University, New Haven, Connecticut.,Department of Pediatrics, Yale University, New Haven, Connecticut.,Department of Applied Physics, Yale University, New Haven, Connecticut
| | - Christine P Hendon
- Department of Electrical Engineering, Columbia University, New York, New York
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Stagnaro N, Rizzo F, Torre M, Cittadini G, Magnano G. Multimodality imaging of pediatric airways disease: indication and technique. Radiol Med 2017; 122:419-429. [PMID: 28224400 DOI: 10.1007/s11547-017-0737-7] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2017] [Accepted: 01/31/2017] [Indexed: 01/09/2023]
Abstract
Congenital and acquired airway anomalies represent a relatively common albeit diagnostic and therapeutic challenge, even for the most skilled operators in dedicated centers. Airway malformations encompass a wide spectrum of pathologies involving the larynx, trachea and bronchi, esophagus, mediastinal vessels. These developmental lesions are often isolated but the association of two or more anomalies is not infrequent. From the traditional chest X-ray to the newest applications of Optical Coherence Tomography, non- or mini-invasive diagnostic techniques represent useful tools to integrate invasive procedures. Comprehensive knowledge of the characteristics of each diagnostic test is mandatory for its useful application. The aim of our paper is to analyze the clinical indications for Imaging the Airway disease in pediatric population, and describe the diagnostic techniques. Only by a close interaction between all the operators involved in diagnosis and treatment of pediatric airway, as it happens in Multidisciplinary Airway Team, the non- or mini-invasive imaging is effective.
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Affiliation(s)
- Nicola Stagnaro
- Radiology Unit, IRCCS Istituto Giannina Gaslini, Genoa, Italy.
| | - Francesca Rizzo
- Radiology Unit, IRCCS Istituto Giannina Gaslini, Genoa, Italy
| | - Michele Torre
- Airway Unit, IRCCS Istituto Giannina Gaslini, Genoa, Italy
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Andolfi M, Potenza R, Capozzi R, Liparulo V, Puma F, Yasufuku K. The role of bronchoscopy in the diagnosis of early lung cancer: a review. J Thorac Dis 2016; 8:3329-3337. [PMID: 28066614 PMCID: PMC5179455 DOI: 10.21037/jtd.2016.11.81] [Citation(s) in RCA: 37] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2016] [Accepted: 10/20/2016] [Indexed: 12/25/2022]
Abstract
Lung cancer is the leading cause of cancer-related deaths worldwide with an overall 5-year survival rate of 17% after diagnoses. Indeed many patients tend to have a very poor prognosis, due to being diagnosed at an advanced stage. Conversely patients who are diagnosed at an early stage have a 5-year survival >70%, indicating that early detection of lung cancer is crucial to improve survival. Although flexible bronchoscopy is a relatively non-invasive procedure for patients suspected of having lung cancer, only 29% of carcinoma in situ (CIS) and 69% of microinvasive tumors were detectable using white light bronchoscopy (WLB) alone. As a result, in the past two decades, new bronchoscopic techniques have been developed to increase the yield and diagnostic accuracy, such as autofluorescence bronchoscopy (AFB), narrow band imaging (NBI) and high magnification bronchovideoscopy (HMB). However, due to the low specificity and the limitation to detect only proximal bronchial tree, new probe-based technologies have been introduced: radial endobronchial ultrasound (R-EBUS), optical coherence tomography (OCT), confocal laser endomicroscopy (CLE) and laser Raman spectroscopy (LRS). To date, although tissue biopsy remains the gold standard for diagnosing malignant/premalignant airway disease and some techniques are still investigational, bronchoscopic technologies can be considered the safest and most accurate tools to evaluate both central and distal airway mucosa.
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Affiliation(s)
- Marco Andolfi
- Division of Thoracic Surgery, S. Maria della Misericordia Hospital, University of Perugia Medical School, Perugia, Italy
| | - Rossella Potenza
- Division of Thoracic Surgery, S. Maria della Misericordia Hospital, University of Perugia Medical School, Perugia, Italy
| | - Rosanna Capozzi
- Division of Thoracic Surgery, S. Maria della Misericordia Hospital, University of Perugia Medical School, Perugia, Italy
| | - Valeria Liparulo
- Division of Thoracic Surgery, S. Maria della Misericordia Hospital, University of Perugia Medical School, Perugia, Italy
| | - Francesco Puma
- Division of Thoracic Surgery, S. Maria della Misericordia Hospital, University of Perugia Medical School, Perugia, Italy
| | - Kazuhiro Yasufuku
- Division of Thoracic Surgery, Toronto General Hospital, University Health Network, Toronto, ON, Canada
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Abstract
PURPOSE OF REVIEW This article reviews the current literature for the purpose of developing a practical approach for the diagnosis and management of primary tracheal tumors. RECENT FINDINGS Because of nonspecific symptoms, tracheal tumors remain a diagnostic challenge. Currently available management strategies are not being optimally utilized due to lack of physician awareness and knowledge. The use of newer diagnostic modalities has increased diagnostic accuracy resulting in earlier detection in recent years. This review describes currently available diagnostic modalities along with relatively newer ones such as virtual bronchoscopy, anatomic Optical Coherence Tomography, spectroscopic techniques, and endobronchial ultrasonography. We will review and discuss management strategies including surgical options, adjuvant therapies, and interventional pulmonary techniques including their role in palliation. SUMMARY Early detection along with improved surgical and interventional pulmonology techniques has led to a decline in the death rates from tracheal cancer in recent years. However, further studies are required to define the role of chemotherapeutic agents, combination therapies, and novel techniques such as tracheal transplantation, in the management of primary tracheal tumors. More robust evidence-based studies are needed to provide evidence for clinical practice guidelines for the treatment of primary tracheal tumors.
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Chen Y, Ding M, Guan WJ, Wang W, Luo WZ, Zhong CH, Jiang M, Jiang JH, Gu YY, Li SY, Zhong NS. Validation of human small airway measurements using endobronchial optical coherence tomography. Respir Med 2015; 109:1446-53. [PMID: 26427628 DOI: 10.1016/j.rmed.2015.09.006] [Citation(s) in RCA: 29] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/05/2015] [Revised: 09/08/2015] [Accepted: 09/09/2015] [Indexed: 10/23/2022]
Abstract
BACKGROUND Small airway remodeling is the cardinal feature underlying chronic airway diseases. There is no modality which identifies small airway pathological changes, which is crucial for early diagnosis, efficacy and prognostic assessment. OBJECTIVE To evaluate the usefulness of endobronchial optical coherence tomography (EB-OCT) in assessing small airways morphology in vivo. METHODS Twelve patients with pulmonary nodules scheduled for lung resection underwent spirometry, multi-detector computed tomography (MDCT) and EB-OCT. We measured D(mean) (mean luminal diameter), Ai (inner luminal area), Aw (airway wall area) and Aw% [Aw/(Ai + Aw) × 100%] from the 3rd to 5th generation bronchi of RB9 segment by MDCT. D(mean), Ai, Aw and Aw% from the 3rd to 9th generation bronchi of RB9 segment were measured by EB-OCT and histology. Correlations of these parameters, measured by three different methods, were evaluated. We recruited 4 COPD patients to determine if EB-OCT could identify peripheral airway remodeling. RESULTS The 4 parameters, measured by CT and EB-OCT, correlated significantly [D(mean) (r = 0.991), Ai (r = 0.997), Aw (r = 0.997), Aw% (r = 0.991), all P < 0.01]. Significant correlation were found for these parameters, measured by histology and EB-OCT, from the 3rd to 5th generation bronchi [D(mean) (r = 0.989), Ai (r = 0.997), Aw (r = 0.999), Aw% (r = 0.988), all P < 0.01], and from the 6th to 9th generation bronchi [D(mean) (r = 0.979), Ai (r = 0.997), Aw (r = 0.994) and Aw% (r = 0.988), all P < 0.01]. Significant small airways morphological abnormalities were observed in COPD patients. CONCLUSIONS EB-OCT, a minimally invasive imaging modality with high-resolution, is useful and clinically practical for assessing proximal and distal airways of human compared with CT and histology.
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Affiliation(s)
- Yu Chen
- State Key Laboratory of Respiratory Disease, National Clinical Research Center for Respiratory Disease, Guangzhou Institute of Respiratory Disease, First Affiliated Hospital of Guangzhou Medical University, Guangzhou, Guangdong, China
| | - Ming Ding
- State Key Laboratory of Respiratory Disease, National Clinical Research Center for Respiratory Disease, Guangzhou Institute of Respiratory Disease, First Affiliated Hospital of Guangzhou Medical University, Guangzhou, Guangdong, China
| | - Wei-jie Guan
- State Key Laboratory of Respiratory Disease, National Clinical Research Center for Respiratory Disease, Guangzhou Institute of Respiratory Disease, First Affiliated Hospital of Guangzhou Medical University, Guangzhou, Guangdong, China
| | - Wei Wang
- Department of Cardiology, First Affiliated Hospital of Guangzhou Medical University, Guangzhou, Guangdong, China
| | - Wei-zhan Luo
- State Key Laboratory of Respiratory Disease, National Clinical Research Center for Respiratory Disease, Guangzhou Institute of Respiratory Disease, First Affiliated Hospital of Guangzhou Medical University, Guangzhou, Guangdong, China
| | - Chang-hao Zhong
- State Key Laboratory of Respiratory Disease, National Clinical Research Center for Respiratory Disease, Guangzhou Institute of Respiratory Disease, First Affiliated Hospital of Guangzhou Medical University, Guangzhou, Guangdong, China
| | - Mei Jiang
- State Key Laboratory of Respiratory Disease, National Clinical Research Center for Respiratory Disease, Guangzhou Institute of Respiratory Disease, First Affiliated Hospital of Guangzhou Medical University, Guangzhou, Guangdong, China
| | - Ju-hong Jiang
- Department of Pathology, First Affiliated Hospital of Guangzhou Medical University, Guangzhou, Guangdong, China
| | - Ying-ying Gu
- Department of Pathology, First Affiliated Hospital of Guangzhou Medical University, Guangzhou, Guangdong, China
| | - Shi-yue Li
- State Key Laboratory of Respiratory Disease, National Clinical Research Center for Respiratory Disease, Guangzhou Institute of Respiratory Disease, First Affiliated Hospital of Guangzhou Medical University, Guangzhou, Guangdong, China.
| | - Nan-shan Zhong
- State Key Laboratory of Respiratory Disease, National Clinical Research Center for Respiratory Disease, Guangzhou Institute of Respiratory Disease, First Affiliated Hospital of Guangzhou Medical University, Guangzhou, Guangdong, China.
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McLaughlin RA, Noble PB, Sampson DD. Optical coherence tomography in respiratory science and medicine: from airways to alveoli. Physiology (Bethesda) 2015; 29:369-80. [PMID: 25180266 DOI: 10.1152/physiol.00002.2014] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
Optical coherence tomography is a rapidly maturing optical imaging technology, enabling study of the in vivo structure of lung tissue at a scale of tens of micrometers. It has been used to assess the layered structure of airway walls, quantify both airway lumen caliber and compliance, and image individual alveoli. This article provides an overview of the technology and reviews its capability to provide new insights into respiratory disease.
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Affiliation(s)
- Robert A McLaughlin
- Optical & Biomedical Engineering Laboratory, School of Electrical, Electronic & Computer Engineering, The University of Western Australia, Perth, Australia;
| | - Peter B Noble
- School of Anatomy, Physiology & Human Biology, and Centre for Neonatal Research & Education, School of Paediatrics and Child Health, The University of Western Australia, Crawley, Australia; and
| | - David D Sampson
- Optical & Biomedical Engineering Laboratory, School of Electrical, Electronic & Computer Engineering, The University of Western Australia, Perth, Australia; Centre for Microscopy, Characterisation & Analysis, The University of Western Australia, Perth, Australia
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Rodrigues AJ, Takimura CK, Lemos Neto PA, Figueiredo VR. Optical coherence tomography in conjunction with bronchoscopy. J Bras Pneumol 2012; 38:174-80. [PMID: 22576424 DOI: 10.1590/s1806-37132012000200005] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2011] [Accepted: 01/30/2012] [Indexed: 11/22/2022] Open
Abstract
OBJECTIVE To evaluate the feasibility of and the potential for using optical coherence tomography in conjunction with conventional bronchoscopy in the evaluation of the airways. METHODS This was a pilot study based on an ex vivo experimental model involving three animals: one adult New Zealand rabbit and two Landrace pigs. An optical coherence tomography imaging catheter was inserted through the working channel of a flexible bronchoscope in order to reach the distal trachea of the animals. Images of the walls of the trachea were systematically taken along its entire length, from the distal to the proximal portion. RESULTS The imaging catheter was easily adapted to the working channel of the bronchoscope. High-resolution images of cross sections of the trachea were taken in real time, precisely delineating microstructures, such as the epithelium, submucosa, and cartilage, as well as the adventitia of the anterior and lateral tracheal walls. The corresponding layers of the epithelium, mucosa, and cartilage were clearly differentiated. The mucosa, submucosa, and trachealis muscle were clearly identified in the posterior wall. CONCLUSIONS It is feasible to use an optical coherence tomography imaging catheter in combination with a flexible bronchoscope. Optical coherence tomography produces high-resolution images that reveal the microanatomy of the trachea, including structures that are typically seen only on images produced by conventional histology.
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Affiliation(s)
- Ascedio José Rodrigues
- Instituto do Coração Serviço de Endoscopia Respiratória, Hospital das Clínicas, Faculdade de Medicina, Universidade de São Paulo, São Paulo, SP, Brazil.
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14
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Kennedy BF, Koh SH, McLaughlin RA, Kennedy KM, Munro PRT, Sampson DD. Strain estimation in phase-sensitive optical coherence elastography. BIOMEDICAL OPTICS EXPRESS 2012; 3:1865-79. [PMID: 22876350 PMCID: PMC3409705 DOI: 10.1364/boe.3.001865] [Citation(s) in RCA: 90] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/10/2012] [Revised: 06/28/2012] [Accepted: 07/12/2012] [Indexed: 05/02/2023]
Abstract
We present a theoretical framework for strain estimation in optical coherence elastography (OCE), based on a statistical analysis of displacement measurements obtained from a mechanically loaded sample. We define strain sensitivity, signal-to-noise ratio and dynamic range, and derive estimates of strain using three methods: finite difference, ordinary least squares and weighted least squares, the latter implemented for the first time in OCE. We compare theoretical predictions with experimental results and demonstrate a ~12 dB improvement in strain sensitivity using weighted least squares compared to finite difference strain estimation and a ~4 dB improvement over ordinary least squares strain estimation. We present strain images (i.e., elastograms) of tissue-mimicking phantoms and excised porcine airway, demonstrating in each case clear contrast based on the sample's elasticity.
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Affiliation(s)
- Brendan F. Kennedy
- Optical + Biomedical Engineering Laboratory, School of Electrical, Electronic and Computer Engineering, The University of Western Australia, 35 Stirling Highway, Crawley, Western Australia 6009, Australia
| | - Sze Howe Koh
- Optical + Biomedical Engineering Laboratory, School of Electrical, Electronic and Computer Engineering, The University of Western Australia, 35 Stirling Highway, Crawley, Western Australia 6009, Australia
| | - Robert A. McLaughlin
- Optical + Biomedical Engineering Laboratory, School of Electrical, Electronic and Computer Engineering, The University of Western Australia, 35 Stirling Highway, Crawley, Western Australia 6009, Australia
| | - Kelsey M. Kennedy
- Optical + Biomedical Engineering Laboratory, School of Electrical, Electronic and Computer Engineering, The University of Western Australia, 35 Stirling Highway, Crawley, Western Australia 6009, Australia
| | - Peter R. T. Munro
- Optical + Biomedical Engineering Laboratory, School of Electrical, Electronic and Computer Engineering, The University of Western Australia, 35 Stirling Highway, Crawley, Western Australia 6009, Australia
- Centre for Microscopy, Characterisation and Analysis, The University of Western Australia, 35 Stirling Highway, Crawley, Western Australia, 6009, Australia
| | - David D. Sampson
- Optical + Biomedical Engineering Laboratory, School of Electrical, Electronic and Computer Engineering, The University of Western Australia, 35 Stirling Highway, Crawley, Western Australia 6009, Australia
- Centre for Microscopy, Characterisation and Analysis, The University of Western Australia, 35 Stirling Highway, Crawley, Western Australia, 6009, Australia
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15
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Guo X, Wu G, Wei H, Deng X, Yang H, Ji Y, He Y, Guo Z, Xie S, Zhong H, Zhao Q, Zhu Z. Quantification of glucose diffusion in human lung tissues by using Fourier domain optical coherence tomography. Photochem Photobiol 2012; 88:311-6. [PMID: 22188341 DOI: 10.1111/j.1751-1097.2011.01065.x] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
In this study, we report permeability coefficients of 30% glucose diffusion by the optical coherence tomography signal slope (OCTSS) method in four kinds of human lung tissue in vitro: normal lung tissue, benign granulomatosis lung tissue, squamous cell carcinoma and adenocarcinoma tumor. To quantify the permeability coefficient of the agent, the monitored region was 80 μm thickness at a tissue depth of ca 230 μm from the surface. The permeability coefficients of 30% glucose from 10 independent experiments were averaged and found to be (1.35 ± 0.13) × 10(-5) cm s(-1) from the normal lung tissue, (1.78 ± 0.21) × 10(-5) cm s(-1) from the benign granulomatosis lung tissue, (2.88 ± 0.19) × 10(-5) cm s(-1) from the adenocarcinoma tumor and (3.53 ± 0.25) × 10(-5) cm s(-1) from the squamous cell carcinoma, respectively. It could be clearly seen that the permeability coefficients of 30% glucose increase ca 32%, 113% and 162% in the benign granulomatosis, adenocarcinoma tumor and squamous cell carcinoma of human lung tissue compared with that from the normal lung tissue, respectively. Therefore, we inferred from this pilot study that the OCT imaging is a feasible method to distinguish normal and cancer lung tissue.
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Affiliation(s)
- Xiao Guo
- MOE Key Laboratory of Laser Life Science and Institute of Laser Life Science, College of Biophotonics, South China Normal University, Guangzhou, China.
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16
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Hou R, Le T, Murgu SD, Chen Z, Brenner M. Recent advances in optical coherence tomography for the diagnoses of lung disorders. Expert Rev Respir Med 2011; 5:711-24. [PMID: 21955240 PMCID: PMC3393648 DOI: 10.1586/ers.11.59] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
There have been many advances in the field of diagnostic and therapeutic pulmonary medicine in the past several years, with major progress in the field of imaging. Optical coherence tomography (OCT) is a high-resolution (micron level) imaging modality currently being advanced with the potential to image airway wall structures in real time and at higher resolution than previously possible. OCT has the potential to increase the sensitivity and specificity of biopsies, create 3D images of the airway to guide diagnostics, and may have a future role in diverse areas such as the evaluation and treatment of patients with obstructive sleep apnea, tracheal stenosis, airway remodeling and inhalation injury. OCT has recently been investigated to monitor airway compliance in chronic obstructive pulmonary disease and asthma patients as well as differentiate causes of pulmonary hypertension. In future clinical and research applications, OCT will likely be combined with other endoscopic based modalities such as ultrasound, spectroscopy, confocal, and/or photoacoustic tomography to determine functional and biomolecular properties. This article discusses the current uses of OCT, its potential applications, as it relates to specific pulmonary diseases, and the future directions for OCT.
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Affiliation(s)
- Randy Hou
- Pulmonary and Critical Care Medicine, Department of Medicine, University of California School of Medicine, Irvine, CA, USA
| | - Tho Le
- Pulmonary and Critical Care Medicine, Department of Medicine, University of California School of Medicine, Irvine, CA, USA
| | - Septimiu D Murgu
- Pulmonary and Critical Care Medicine, Department of Medicine, University of California School of Medicine, Irvine, CA, USA
| | - Zhongping Chen
- Beckman Laser Institute, University of California, Irvine, CA, USA
| | - Matt Brenner
- Pulmonary and Critical Care Medicine, Department of Medicine, University of California School of Medicine, Irvine, CA, USA
- Beckman Laser Institute, University of California, Irvine, CA, USA
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17
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Robertson C, Lee SW, Ahn YC, Mahon S, Chen Z, Brenner M, George SC. Investigating in vivo airway wall mechanics during tidal breathing with optical coherence tomography. JOURNAL OF BIOMEDICAL OPTICS 2011; 16:106011. [PMID: 22029358 PMCID: PMC3210193 DOI: 10.1117/1.3642006] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/15/2023]
Abstract
Optical coherence tomography (OCT) is a nondestructive imaging technique offering high temporal and spatial resolution, which makes it a natural choice for assessing tissue mechanical properties. We have developed methods to mechanically analyze the compliance of the rabbit trachea in vivo using tissue deformations induced by tidal breathing, offering a unique tool to assess the behavior of the airways during their normal function. Four-hundred images were acquired during tidal breathing with a custom-built endoscopic OCT system. The surface of the tissue was extracted from a set of these images via image processing algorithms, filtered with a bandpass filter set at respiration frequency to remove cardiac and probe motion, and compared to ventilatory pressure to calculate wall compliance. These algorithms were tested on elastic phantoms to establish reliability and reproducibility. The mean tracheal wall compliance (in five animals) was 1.3±0.3×10(-5) (mm Pa)(-1). Unlike previous work evaluating airway mechanics, this new method is applicable in vivo, noncontact, and loads the trachea in a physiological manner. The technique may have applications in assessing airway mechanics in diseases such as asthma that are characterized by significant airway remodeling.
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Affiliation(s)
- Claire Robertson
- University of California, Irvine, Department of Biomedical Engineering, Irvine, California 92697, USA
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18
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Coxson HO, Eastwood PR, Williamson JP, Sin DD. Phenotyping airway disease with optical coherence tomography. Respirology 2011; 16:34-43. [PMID: 21044229 DOI: 10.1111/j.1440-1843.2010.01888.x] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
Airway diseases are a major concern around the world. However, the pace of new drug and biomarker discovery has lagged behind those of other common disorders such as cardiovascular diseases and diabetes. One major barrier in airway research has been the inability to accurately visualize large or small airway remodelling or dysplastic/neoplastic (either pre or early cancerous) changes using non- or minimally invasive instruments. The advent of optical coherence tomography (OCT) has the potential to revolutionize airway research and management by allowing investigators and clinicians to visualize the airway with resolution approaching histology and without exposing patients to harmful effects of ionizing radiation. Thus, with the aid of OCT, we may be able to accurately determine and quantify the extent of airway remodelling in asthma and chronic obstructive pulmonary disease, detect early pre-cancerous lesions in smokers for chemoprevention, study the upper airway anatomy of patients with obstructive sleep apnea in real time while they are asleep and facilitate optimal selection of stents for those with tracheal obstruction. In this paper, we review the current state of knowledge of OCT and its possible application in airway diseases.
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Affiliation(s)
- Harvey O Coxson
- Providence Heart and Lung Institute and The UBC James Hogg Research Center, St. Paul's Hospital, Vancouver, British Columbia, Canada
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19
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Primary major airway tumors; management and results. Eur J Cardiothorac Surg 2011; 39:749-54. [DOI: 10.1016/j.ejcts.2010.08.047] [Citation(s) in RCA: 37] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/28/2010] [Revised: 08/11/2010] [Accepted: 08/19/2010] [Indexed: 11/21/2022] Open
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20
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Lau B, McLaughlin RA, Curatolo A, Kirk RW, Gerstmann DK, Sampson DD. Imaging true 3D endoscopic anatomy by incorporating magnetic tracking with optical coherence tomography: proof-of-principle for airways. OPTICS EXPRESS 2010; 18:27173-80. [PMID: 21196994 DOI: 10.1364/oe.18.027173] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/15/2023]
Abstract
Endoscopic imaging using optical coherence tomography (OCT) has been demonstrated as clinically useful in the assessment of human airways. These airways have a complex 3D structure, bending, tapering and bifurcating. Previously published 3D OCT reconstructions have not accounted for changes in the orientation and trajectory of the endoscopic probe as it moves through the airway during imaging. We propose a novel endoscopic setup incorporating a magnetic tracking system that accounts for these changes, yielding reconstructions that reveal the true 3D nature of the imaged anatomy. We characterize the accuracy of the system, and present the first published magnetic tracker-assisted endoscopic OCT reconstructions using a phantom airway.
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Affiliation(s)
- Brandon Lau
- School of Electrical, Electronic & Computer Engineering, University of Western Australia, Crawley, WA, Australia
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21
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Michel RG, Kinasewitz GT, Fung KM, Keddissi JI. Optical Coherence Tomography as an Adjunct to Flexible Bronchoscopy in the Diagnosis of Lung Cancer. Chest 2010; 138:984-8. [DOI: 10.1378/chest.10-0753] [Citation(s) in RCA: 70] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/01/2022] Open
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22
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Yarmus L, Feller-Kopman D. Bronchoscopes of the twenty-first century. Clin Chest Med 2010; 31:19-27, Table of Contents. [PMID: 20172429 DOI: 10.1016/j.ccm.2009.11.002] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
Over the past century, bronchoscopy has become an essential tool for pulmonologists and thoracic surgeons, who for many years have employed bronchoscopy with such therapeutic modalities as laser therapy, electrocautery, cryotherapy, and stent placement. Over the past decade, advanced imaging techniques, such as autofluoresence bronchoscopy, electromagnetic navigation, narrow-band imaging, confocal fluorescence microendoscopy, and endobronchial ultrasound, have greatly expanded the diagnostic utility of bronchoscopy. This article reviews the technological advances in the field of diagnostic bronchoscopy.
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Affiliation(s)
- Lonny Yarmus
- Interventional Pulmonology, Division of Pulmonary and Critical Care, The Johns Hopkins Hospital, 1830 East Monument Street, 5th Floor, Baltimore, MD 21205, USA
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23
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Abstract
Diagnostic bronchoscopy has undergone two major paradigm shifts in the last 40 years. First, the advent of flexible bronchoscopy gave chest physicians improved access to the tracheobronchial tree with a rapid learning curve and greater patient comfort compared with rigid bronchoscopy. The second paradigm shift has evolved over the last 5 years with the proliferation of new technologies that have significantly enhanced the diagnostic capabilities of flexible bronchoscopy compared with traditional methods. At the forefront of these new technologies is endobronchial ultrasound. In its various forms, endobronchial ultrasound has improved diagnostic yield for pulmonary masses, nodules, intrathoracic adenopathy, and disease extent, thereby reducing the need for more invasive surgical interventions. Various navigational bronchoscopy systems have become available to increase flexible bronchoscope access to small peripheral pulmonary lesions. Furthermore, various modalities of airway assessment, including optical microscopic imaging technologies, may play significant roles in the diagnosis of a variety of pulmonary diseases in the future. Finally, the combination of new diagnostic bronchoscopy technologies and novel approaches in molecular analysis and biomarker assessment hold promise for enhanced diagnosis and personalized management of many pulmonary disorders. In this review, we provide a contemporary review of diagnostic bronchoscopy developments over the past decade.
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Affiliation(s)
- Andrew R Haas
- Clinical Operations, Interventional Pulmonology and Thoracic Oncology, Pulmonary, Allergy, and Critical Care Division, University of Pennsylvania Medical Center, 3600 Spruce Street, Philadelphia, PA 19104-4283, USA.
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24
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25
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Yarmus L, Ernst A, Feller-Kopman D. Emerging technologies for the thorax: indications, management and complications. Respirology 2009; 15:208-19. [PMID: 20051044 DOI: 10.1111/j.1440-1843.2009.01680.x] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
The field of interventional pulmonology has rapidly expanded to include the management and treatment of complex diseases of the chest. The management of central airway obstruction, pleural disease diagnosis, treatment and palliation, advanced bronchoscopic techniques to aid in the diagnosis of lung cancer and innovative therapies to treat asthma and COPD have all emerged over the past decade. As astute clinicians, we are all aware of the risks and benefits of using these therapies to treat our patients. In order to appropriately treat and manage these often complex medical situations, the physician should have an expert knowledge of all available modalities, the expertise to safely perform the procedure and the ability to minimize the risk of and manage the associated complications that may arise. In this chapter we review and update some of the bronchoscopic and pleural interventions offered by interventional pulmonologists as well as the associated complications and management.
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Affiliation(s)
- Lonny Yarmus
- Division of Interventional Pulmonology, The Johns Hopkins Hospital, Baltimore, Maryland 21205, USA
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26
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Mueller-Lisse U, Meissner O, Bauer M, Weber C, Babaryka G, Stief C, Reiser M, Mueller-Lisse U. Catheter-based Intraluminal Optical Coherence Tomography Versus Endoluminal Ultrasonography of Porcine Ureter Ex Vivo. Urology 2009; 73:1388-91. [DOI: 10.1016/j.urology.2008.11.053] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2008] [Revised: 10/04/2008] [Accepted: 11/15/2008] [Indexed: 10/20/2022]
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27
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Williamson JP, McLaughlin RA, Phillips MJ, Armstrong JJ, Becker S, Walsh JH, Sampson DD, Hillman DR, Eastwood PR. Using optical coherence tomography to improve diagnostic and therapeutic bronchoscopy. Chest 2009; 136:272-276. [PMID: 19225058 DOI: 10.1378/chest.08-2800] [Citation(s) in RCA: 32] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022] Open
Abstract
Flexible bronchoscopy is a common procedure that is used in both diagnostic and therapeutic settings but does not readily permit measurement of central airway dimensions. Anatomic optical coherence tomography (a OCT), a modification of conventional optical coherence tomography (OCT), is a novel light-based imaging tool with the capacity to measure the diameter and lumen area of the central airways accurately during bronchoscopy. This study describes the first clinical use of aOCT imaging in the lower airways in three individuals with common endobronchial pathologies. During bronchoscopy, a specialized fiberoptic probe was passed through the biopsy channel of a standard flexible bronchoscope to the site of airway pathology. Airway dimensions were measured from the generated cross-sectional images in three subjects, one with subglottic tracheal stenosis (subject 1), one with malignant left main bronchus (LMB) obstruction (subject 2), and another with severe tracheomalacia (subject 3). Measured dimensions included internal airway diameter, cross-sectional area, and, in subject 1, stenosis length. Tracheal stenosis dimensions, measured using aOCT imaging, correlated with chest CT scan findings and guided the choice of airway stent (subject 1). The airway beyond a malignant obstruction of the LMB, and beyond bronchoscopic view, could be imaged using aOCT, and the distal extent of obstructing tumor identified (subject 2). The severity of newly diagnosed tracheomalacia was able to be quantified using aOCT imaging (subject 3). aOCT imaging during bronchoscopy allows accurate real-time airway measurements and may assist bronchoscopic assessment.
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Affiliation(s)
- Jonathan P Williamson
- Department of Pulmonary Physiology, Sir Charles Gairdner Hospital, Perth, WA, Australia.
| | - Robert A McLaughlin
- Optical + Biomedical Engineering Laboratory, School of Electrical, Electronic & Computer Engineering, University of Western Australia, Perth, WA, Australia
| | - Martin J Phillips
- Department of Pulmonary Physiology, Sir Charles Gairdner Hospital, Perth, WA, Australia
| | - Julian J Armstrong
- Optical + Biomedical Engineering Laboratory, School of Electrical, Electronic & Computer Engineering, University of Western Australia, Perth, WA, Australia
| | - Sven Becker
- Optical + Biomedical Engineering Laboratory, School of Electrical, Electronic & Computer Engineering, University of Western Australia, Perth, WA, Australia
| | - Jennifer H Walsh
- West Australian Sleep Disorders Research Institute, Perth, WA, Australia
| | - David D Sampson
- Optical + Biomedical Engineering Laboratory, School of Electrical, Electronic & Computer Engineering, University of Western Australia, Perth, WA, Australia
| | - David R Hillman
- Department of Pulmonary Physiology, Sir Charles Gairdner Hospital, Perth, WA, Australia
| | - Peter R Eastwood
- Department of Pulmonary Physiology, Sir Charles Gairdner Hospital, Perth, WA, Australia
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28
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McLaughlin RA, Williamson JP, Phillips MJ, Armstrong JJ, Becker S, Hillman DR, Eastwood PR, Sampson DD. Applying anatomical optical coherence tomography to quantitative 3D imaging of the lower airway. OPTICS EXPRESS 2008; 16:17521-9. [PMID: 18958032 DOI: 10.1364/oe.16.017521] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/15/2023]
Abstract
Endoscopic treatment of lower airway pathologies requires accurate quantification of airway dimensions. We demonstrate the application of a real-time endoscopic optical coherence tomography system that can image lower airway anatomy and quantify airway lumen dimensions intra-operatively. Results demonstrate the ability to acquire 3D scans of airway anatomy and include comparison against a pre-operative X-ray CT. The paper also illustrates the capability of the system to assess the real-time dynamic changes within the airway that occur during respiration.
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Affiliation(s)
- Robert A McLaughlin
- Optical + Biomedical Engineering Laboratory, School of Electrical, Electronic & Computer Engineering, University of Western Australia, Crawley, WA 6009, Australia.
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29
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Brenner M, Kreuter K, Ju J, Mahon S, Tseng L, Mukai D, Burney T, Guo S, Su J, Tran A, Batchinsky A, Cancio LC, Narula N, Chen Z. In vivo optical coherence tomography detection of differences in regional large airway smoke inhalation induced injury in a rabbit model. JOURNAL OF BIOMEDICAL OPTICS 2008; 13:034001. [PMID: 18601546 PMCID: PMC2778034 DOI: 10.1117/1.2939400] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/15/2023]
Abstract
Smoke inhalation injury causes acute airway injury that may result in airway compromise with significant morbidity and mortality. We investigate the ability of high resolution endobronchial optical coherence tomography (OCT) to obtain real-time images for quantitatively assessing regional differences between upper tracheal versus lower tracheal and bronchial airway injury responses to smoke inhalation in vivo using a prototype spectral domain (SLD)-OCT system we constructed, and flexible fiber optic probes. 33 New Zealand White rabbits are intubated and mechanically ventilated. The treatment groups are exposed to inhaled smoke. The OCT probe is introduced through the endotracheal tube and maintained in place for 5 to 6 h. Images of airway mucosa and submucosa are obtained at baseline and at specified intervals postexposure. Starting within less than 15 min after smoke inhalation, there is significant airway thickening in the smoke-exposed animals. This is maintained over 5 h of imaging studies. The lower tracheal airway changes, correlating closely with carboxyhemoglobin levels, are much greater than upper tracheal changes. Significant differences are seen in lower trachea and bronchi after acute smoke inhalation compared to upper trachea as measured in vivo by minimally invasive OCT. OCT is capable of quantitatively detecting regional changes in airway swelling following inhalation injury.
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Affiliation(s)
- Matthew Brenner
- University of California, Irvine, Beckman Laser Institute, Irvine, California 92612, USA.
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30
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Abstract
Interventional pulmonology (IP) provides comprehensive care to patients with structural airway disorders and pleural diseases. A growing armamentarium of diagnostic and therapeutic tools has expanded the interventional pulmonologist's ability to care for pulmonary patients with complex abnormalities, often in concert and close collaboration with physicians in other specialties, such as thoracic surgery. Innovative technologies promise to have an impact on diseases and clinical entities not traditionally treated by invasive pulmonary interventions, such as asthma, COPD, and the solitary pulmonary nodule. Training, credentialing, reimbursement, and scientific validation remain key necessities for the continued growth of IP, and require a concerted effort by chest physicians and their professional organizations.
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Affiliation(s)
- Momen M Wahidi
- Department of Interventional Pulmonology, Division of Pulmonary and Critical Care Medicine, Duke University Medical Center, Durham, NC, USA
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31
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Brenner M, Kreuter K, Mukai D, Burney T, Guo S, Su J, Mahon S, Tran A, Tseng L, Ju J, Chen Z. Detection of acute smoke-induced airway injury in a New Zealand white rabbit model using optical coherence tomography. JOURNAL OF BIOMEDICAL OPTICS 2007; 12:051701. [PMID: 17994874 DOI: 10.1117/1.2798637] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/25/2023]
Abstract
Optical coherence tomography (OCT) is a micron scale high-resolution optical technology that can provide real-time in vivo images noninvasively. The ability to detect airway mucosal and submucosal injury rapidly will be valuable for a range of pulmonary applications including assessment of acute inhalation smoke and burn injury. OCT has the potential ability to monitor the progression of airway injury changes including edema, hyperemia, and swelling, which are critical clinical components of smoke-inhalation injury. New Zealand white male rabbits exposed to cold smoke from standardized unbleached burned cotton administered during ventilation were monitored for 6 h using a 1.8-mm diameter flexible fiberoptic longitudinal probe that was inserted through the endotracheal tube. The thickness of the epithelial, mucosal, and submucosal layers of the rabbit trachea to the tracheal cartilage was measured using a prototype superluminescent diode OCT system we constructed. OCT was able to detect significant smoke-injury-induced increases in the thickness of the tracheal walls of the rabbit beginning very shortly after smoke administration. Airway wall thickness increased to an average of 120% (+/-33%) of baseline values by 5 h following exposure. OCT is capable of providing real-time, noninvasive images of airway injury changes following smoke exposure. These studies suggest that OCT may have the ability to provide information on potential early indicators of impending smoke-inhalation-induced airway compromise.
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Affiliation(s)
- Matthew Brenner
- University of California-Irvine, Beckman Laser Institute, Irvine, California 92612, USA.
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32
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Cancio LC, Batchinsky AI, Dubick MA, Park MS, Black IH, Gómez R, Faulkner JA, Pfannenstiel TJ, Wolf SE. Inhalation injury: Pathophysiology and clinical care. Burns 2007; 33:681-92. [PMID: 17532146 DOI: 10.1016/j.burns.2006.11.009] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2006] [Accepted: 11/15/2006] [Indexed: 11/28/2022]
Affiliation(s)
- Leopoldo C Cancio
- U.S. Army Institute of Surgical Research, Fort Sam Houston, TX 78234-6315, USA.
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33
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McLennan G, Namati E, Ganatra J, Suter M, O'Brien EE, Lecamwasam K, van Beek EJR, Hoffman EA. Virtual Bronchoscopy. ACTA ACUST UNITED AC 2007. [DOI: 10.1111/j.1617-0830.2007.00087.x] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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Abstract
BACKGROUND Tracheal tumors are uncommon, making up only 0.2% of all respiratory malignancies in the United States. One consequence of this low incidence is that few centers accumulate meaningful experience. Another is the lack of awareness of effective therapy. Bronchial gland tumors demonstrate oncologic diversity and include benign, low-grade, and high-grade malignant tumors. METHODS We reviewed the present knowledge of bronchial gland tumors of the trachea, carina, and bronchi, including the epidemiology, presentation, evaluation, tumor types, and treatment options. RESULTS The malignant bronchial gland tumors, adenoid cystic carcinoma and mucoepidermoid carcinoma, are far more common than benign mucinous cystadenoma or pleomorphic adenoma. Complete resection of localized tumors has excellent long-term results in symptomatic benign tumors. The disease-free survival after resection of malignant tumors is limited by distant metastasis and regional disease, while local recurrence is uncommon. Postoperative mediastinal radiation is now accepted adjuvant therapy. Experience at our institute demonstrates a significant survival advantage for patients with complete resection compared to unresectable patients. CONCLUSIONS Expanding knowledge of diagnostic evaluation and surgical therapy can improve the long-term survival of patients with tracheobronchial gland tumors.
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