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Radiological investigations are paramount in the diagnosis and management of various pulmonary diseases. Two essential investigations are the Pulmonary Angiogram and the Positron Emission Tomography (PET) Scan.
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Diagnosing lung carcinomas with optical coherence tomography.

Lida P Hariri1, Mari Mino-Kenudson, Michael Lanuti

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Optical coherence tomography (OCT) shows promise for lung carcinoma diagnosis, achieving 82.6% accuracy. While not replacing histology, OCT can aid diagnosis when biopsy tissue is insufficient.

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in vivo microscopylung canceroptical biopsy guidanceoptical frequency domain imagingtransbronchial fine needle aspiration guidance

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Area of Science:

  • Medical Imaging
  • Oncology
  • Pathology

Background:

  • Lung carcinoma diagnosis via tissue biopsy faces challenges due to insufficient tumor samples and lack of architectural detail.
  • Optical coherence tomography (OCT) offers high-resolution, volumetric microarchitecture visualization, exceeding traditional biopsy capabilities.
  • OCT has been proposed as a potential replacement for tissue biopsy in lung cancer diagnosis.

Purpose of the Study:

  • To evaluate if OCT can substitute traditional histology for diagnosing primary lung carcinomas.
  • To develop and validate OCT interpretation criteria for adenocarcinoma, squamous cell carcinoma (SCC), and poorly differentiated carcinoma.
  • To assess the diagnostic accuracy of OCT in distinguishing common lung carcinoma subtypes.

Main Methods:

  • A blinded assessment of 82 ex vivo lung tumor samples was conducted with 3 independent readers.
  • Readers were trained on OCT interpretation criteria for adenocarcinoma, SCC, and poorly differentiated carcinoma.
  • Readers re-evaluated the validation dataset after a 7-month interval, with results compared against independent pathology review.

Main Results:

  • The average diagnostic accuracy for lung carcinomas using OCT was 82.6% (range: 73.7-94.7%).
  • Sensitivity and specificity varied by subtype: Adenocarcinoma (80.3%, 88.6%), SCC (83.3%, 87.0%), and poorly differentiated carcinoma (85.7%, 97.6%).
  • Inter-reader reliability was assessed through repeated interpretations after a 7-month period.

Conclusions:

  • OCT shows encouraging diagnostic performance but cannot fully replace histology for lung carcinoma diagnosis.
  • OCT has significant potential as an adjunct tool to complement tissue biopsy, especially in cases with limited tissue availability.
  • Further research and validation are needed to integrate OCT into routine lung cancer diagnostic workflows.