Early Detection and Diagnosis of Lung Cancer with Endomicroscopy

内镜下肺癌的早期发现和诊断

• 批准号: 10321206
• 负责人: Melissa J Suter
• 金额: $ 63.39万
• 依托单位: MASSACHUSETTS GENERAL HOSPITAL
• 依托单位国家: 美国
• 财政年份: 2021
• 资助国家: 美国
• 起止时间: 2021-01-01 至 2026-12-31
• 项目状态: 未结题
• 来源: https://reporter.nih.gov/project-details/10321206
• 关键词: Address; Advisory Committees; Benign; Biopsy; Biopsy Specimen; Blinded; Breast; Bronchoscopy; Cancer Etiology; Categories; Catheters; Cessation of life; Clinical; Clinical Research; Colon; Custom; Development; Diagnosis; Diagnostic; Diagnostic Procedure; Early Diagnosis; Early Intervention; Enrollment; Evaluation; Feasibility Studies; Goals; Histopathology; Image; Image Analysis; Individual; Laboratories; Lesion; Lung nodule; Malignant Neoplasms; Malignant neoplasm of lung; Methods; Microscopic; Microscopy; Morbidity - disease rate; Nodule; Operative Surgical Procedures; Optical Coherence Tomography; Optics; Pathologist; Pathology; Patients; Physicians; Preventive service; Procedures; Prostate; Randomized; Reader; Research Design; Resolution; Risk; Sheep; Site; Specimen; Survival Rate; Symptoms; Techniques; Technology; Therapeutic Intervention; Time; Tissue Sample; Tissue imaging; Tissues; Visualization; Work; arm; base; cancer diagnosis; computed tomography screening; diagnostic accuracy; falls; high resolution imaging; high risk; human subject; imaging approach; imaging platform; in vivo; low dose computed tomography; microendoscopy; minimally invasive; mortality; novel; optical imaging; public health relevance; safety study; screening; surgical risk; tool; tumor; tumor microenvironment

PROJECT SUMMARY Early diagnosis of lung cancer is critical to patient survival. Unfortunately the vast majority of cases are detected once symptoms arise and the cancer has spread offering patients little hope for cure (average 5-year survival rate < 15%). The U.S. Preventive Services Task Force recommends individuals at high risk of developing lung cancer undergo yearly screening with low dose computed tomography (LDCT). Screening is highly sensitive at detecting lung nodules and has resulted in a reduction in mortality of these patients, however only 5% of nodules detected are likely to be cancer. Diagnosis of lung cancer must be made on the microscopic level which is traditionally done by obtaining tissue specimens for subsequent histopathology examination. Methods for biopsy generally fall under two categories; high-risk surgical and transthoracic procedures that provide a higher diagnostic yield, and low-risk bronchoscopy based procedures that generally have a lower yield. Given that the vast majority of nodules detected by LDCT screening are benign it is critical that the high-risk procedures for diagnosis are avoided. The low diagnostic yields of bronchoscopy based biopsy procedures can be attributed to insufficiently large, inappropriately located, or non-diagnostic tissue sampling. Therefore there is a critical need to dramatically increase the diagnostic yield of low-risk bronchial biopsy approaches. In our laboratory we have developed novel optical coherence tomography (OCT) imaging approaches to provide high-resolution images of tissue microstructure. We have additionally developed and disseminated OCT interpretation criteria for the diagnosis lung cancer. In this proposal we aim to further develop our endobronchial OCT imaging catheters to provide images with superior resolution and contrast with the goal of microscopically guiding biopsy site selection to increase tumor yield (Aim 2), and to use our endomicroscopy images and previously developed image interpretation criteria to provide a preliminary diagnosis of the lesion within the procedure room (Aim 3). The intra-procedural diagnostic endomicroscopy images could be useful complementary information provided to pathologists in addition to the tiny physical biopsy specimens for diagnosis, or to enable immediate diagnosis and treatment of small lesions without requiring a second procedure.

项目摘要 肺癌的早期诊断对于患者生存至关重要。不幸的是，绝大多数案件是 一旦出现症状，癌症就会传播给患者几乎没有治愈的希望（平均5年 存活率<15％）。美国预防服务工作队建议个人高风险 患有低剂量计算机断层扫描（LDCT）的年度肺癌进行年度筛查。筛选是 在检测肺结节方面高度敏感，并导致这些患者的死亡率降低， 但是，只有5％检测到的结节可能是癌症。必须对肺癌进行诊断 微观水平传统上是通过获得随后的组织病理学的组织标本来完成的 考试。活检方法通常属于两类；高风险手术和经胸腔 提供更高诊断产量和低风险支气管镜检查程序的程序，通常 产量较低。鉴于LDCT筛选检测到的绝大多数结节是良性的，这是至关重要的 避免了诊断的高风险程序。基于支气管镜检查的低诊断产率 活检程序可以归因于不足，位置不当或非诊断组织 采样。因此，迫切需要大大增加低风险支气管的诊断产量 活检接近。在我们的实验室中，我们开发了新颖的光学相干断层扫描（OCT）成像 提供组织微观结构的高分辨率图像的方法。我们还开发了 传播诊断肺癌的OCT解释标准。在此提案中，我们的目标是进一步 开发我们的支气管内OCT成像导管，以提供具有较高分辨率的图像，并与 显微镜指导活检部位选择以增加肿瘤产量的目的（AIM 2），并使用我们 内运动图像和先前开发的图像解释标准，以提供初步 诊断程序室内的病变（AIM 3）。手术内诊断内部显微镜检查 图像除了微小的物理外，还可以提供给病理学家提供的互补信息 用于诊断的活检标本，或能够立即诊断和治疗小病变 需要第二个程序。