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The use of endoscopic optical coherence tomography (OCT) in pulmonary medicine has shown significant promise for aiding in the detection and diagnosis of airway pathology, in monitoring disease progression over time, and in assessing dynamic microstructure and function in vivo. Recent technical advances including enhanced resolution and contrast together with novel sophisticated catheter designs to improve usability are key contributing factors to the increased clinical utility of OCT in pulmonology.
To increase the clinical utility of OCT for pulmonary medicine catheters have been designed to navigate the complex pulmonary anatomy, to aid in guiding biopsies, and to provide improved imaging capabilities over conventional OCT catheters. Flexible OCT needle catheters have been designed to confirm the needle position within the targeted nodule and tissue region of interest prior to biopsy. OCT image interpretation criteria to enable the differentiation of nodules from lung parenchyma and also for diagnosing pulmonary pathology relevant to lung cancer have been established and adopted by the College of American Pathologist, and clinical studies are now being conducted to evaluate the feasibility of OCT guided biopsy in vivo. While work is ongoing, we anticipate that in the future OCT guided biopsy may increase the diagnostic yield of bronchial biopsy by not only confirming that the targeted nodule has been reached, but also additionally providing the bronchoscopist with a tool to assess nodule composition and identify regions most likely to yield diagnostic tumor.
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