Using optical coherence tomography to improve diagnostic and therapeutic bronchoscopy

Area of Science:

• Pulmonary Medicine
• Medical Imaging
• Interventional Pulmonology

Background:

• Flexible bronchoscopy is crucial for diagnosing and treating airway conditions but lacks precise dimensional measurement capabilities.
• Conventional optical coherence tomography (OCT) provides high-resolution imaging but requires modification for in-vivo airway assessment.
• Accurate measurement of central airway dimensions is vital for effective management of stenosis, obstruction, and malacia.

Observation:

• This study details the first clinical application of Anatomic optical coherence tomography (aOCT) in the lower airways.
• A specialized fiberoptic probe was integrated into a standard flexible bronchoscope for in-situ imaging.
• aOCT imaging was performed on three patients with distinct endobronchial pathologies: tracheal stenosis, malignant airway obstruction, and tracheomalacia.

Findings:

• aOCT accurately measured airway dimensions, including diameter, lumen area, and stenosis length, in patients with tracheal stenosis.
• The imaging modality successfully visualized the airway beyond a malignant left main bronchus obstruction, identifying tumor extent.
• aOCT quantified the severity of tracheomalacia, providing objective data for clinical assessment.
• Measurements obtained via aOCT correlated with chest CT findings in the stenosis case and guided therapeutic decisions.

Implications:

• Anatomic optical coherence tomography (aOCT) offers accurate, real-time airway measurements during bronchoscopy.
• This technology has the potential to significantly enhance the assessment and management of diverse central airway diseases.
• aOCT may become an indispensable tool for interventional pulmonologists, improving procedural guidance and patient outcomes.