Solitary pulmonary nodule imaging approaches and the role of optical fibre-based technologies

Susan Fernandes, Gareth Williams, Elvira Williams, Katjana Ehrlich, James Stone, Neil Finlayson, Mark Bradley, Robert R. Thomson, Ahsan R. Akram, Kevin Dhaliwal

Research output: Contribution to journalArticlepeer-review

15 Citations (SciVal)

Abstract

Solitary pulmonary nodules (SPNs) are a clinical challenge, given there is no single clinical sign or radiological feature that definitively identifies a benign from a malignant SPN. The early detection of lung cancer has a huge impact on survival outcome. Consequently, there is great interest in the prompt diagnosis, and treatment of malignant SPNs. Current diagnostic pathways involve endobronchial/ transthoracic tissue biopsies or radiological surveillance, which can be associated with suboptimal diagnostic yield, healthcare costs and patient anxiety. Cutting-edge technologies are needed to disrupt and improve, existing care pathways. Optical fibre-based techniques, which can be delivered via the working channel of a bronchoscope or via transthoracic needle, may deliver advanced diagnostic capabilities in patients with SPNs. Optical endomicroscopy, an autofluorescence-based imaging technique, demonstrates abnormal alveolar structure in SPNs in vivo. Alternative optical fingerprinting approaches, such as time-resolved fluorescence spectroscopy and fluorescence-lifetime imaging microscopy, have shown promise in discriminating lung cancer from surrounding healthy tissue. Whilst fibre-based Raman spectroscopy has enabled real-time characterisation of SPNs in vivo. Fibre-based technologies have the potential to enable in situ characterisation and real-time microscopic imaging of SPNs, which could aid immediate treatment decisions in patients with SPNs. This review discusses advances in current imaging modalities for evaluating SPNs, including computed tomography (CT) and positron emission tomography-CT. It explores the emergence of optical fibre-based technologies, and discusses their potential role in patients with SPNs and suspected lung cancer.

Original languageEnglish
Article number2002537
JournalEuropean Respiratory Journal
Volume57
Issue number3
DOIs
Publication statusPublished - 1 Mar 2021

Bibliographical note

Funding Information:
Support statement: This work was supported by Cancer Research UK (grant: A24867), the Engineering and Physical Sciences Research Council (grants: EP/K03197X/1 and EP/S001123/1) and the Medical Research Council (grant: MR/ R017794/1). Funding information for this article has been deposited with the Crossref Funder Registry.

Funding Information:
Conflict of interest: S. Fernandes reports grants from MRC and Boston Scientific, during the conduct of the study. G. Williams has patents planned relating to FLIM. E. Williams has patents planned relating to FLIM. K. Ehrlich has nothing to disclose. J. Stone reports grants from EPSRC and Boston Scientific, during the conduct of the study; and has a patent imaging fibre issued. N. Finlayson reports grants from EPSRC, during the conduct of the study; other from Prothea-X, outside the submitted work. M. Bradley reports grants from MRC, Boston Scientific and EPSRC, during the conduct of the study. R.R. Thomson reports grants from University of Edinburgh, during the conduct of the study. A.R. Akram reports academic grants, during the conduct of the study. K. Dhaliwal reports grants from MRC, Boston Scientific and EPSRC, and reimbursment for travel and consultancy from Mauna Kea Technologies, during the conduct of the study.

Publisher Copyright:
Copyright ©ERS 2021.

Copyright:
Copyright 2021 Elsevier B.V., All rights reserved.

ASJC Scopus subject areas

  • Pulmonary and Respiratory Medicine

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