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In vivo Optical Coherence Tomography Imaging of Preinvasive Bronchial Lesions

Authors' Affiliations: ¹ Cancer Imaging Department, British Columbia Cancer Agency and the University of British Columbia, Vancouver, British Columbia, Canada; ² Department of Medical Biophysics, Princess Margaret Hospital, University of Toronto, Toronto, Ontario, Canada; ³ University of Texas Southwestern Medical Center, Dallas, Texas; and ⁴ Department of Thoracic Oncology and Surgery, International University of Health and Welfare, Mita Hospital, Tokyo, Japan

Requests for reprints: Stephen Lam, Cancer Imaging Department, British Columbia Cancer Agency, 675 West 10 Avenue, Vancouver, British Columbia, Canada V5Z 1L3. Phone: 604-675-8094; Fax: 604-675-8089; E-mail: slam{at}bccancer.bc.ca.

Purpose: Optical coherence tomography (OCT) is an optical imaging method that can visualize cellular and extracellular structures at and below tissue surface. The objective of the study was to determine if OCT could characterize preneoplastic changes in the bronchial epithelium identified by autofluorescence bronchoscopy.

Experimental Design: A 1.5-mm fiberoptic probe was inserted via a bronchoscope into the airways of 138 volunteer heavy smokers participating in a chemoprevention trial and 10 patients with lung cancer to evaluate areas that were found to be normal or abnormal on autofluorescence bronchoscopy. Radial scanning of the airways was done to generate OCT images in real time. Following OCT imaging, the same sites were biopsied for pathologic correlation.

Results: A total of 281 OCT images and the corresponding bronchial biopsies were obtained. The histopathology of these areas includes 145 normal/hyperplasia, 61 metaplasia, 39 mild dysplasia, 10 moderate dysplasia, 6 severe dysplasia, 7 carcinoma in situ, and 13 invasive carcinomas. Quantitative measurement of the epithelial thickness showed that invasive carcinoma was significantly different than carcinoma in situ (P = 0.004) and dysplasia was significantly different than metaplasia or hyperplasia (P = 0.002). In addition, nuclei of the cells corresponding to histologic results became more discernible in lesions that were moderate dysplasia or worse compared with lower-grade lesions.

Conclusion: Preliminary data suggest that autofluorescence bronchoscopy–guided OCT imaging of bronchial lesions is technically feasible. OCT may be a promising nonbiopsy tool for in vivo imaging of preneoplastic bronchial lesions to study their natural history and the effect of chemopreventive intervention.