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Pulmonary Procedures |

Optical Coherence Tomography as an Adjunct in the Evaluation of Endobronchial Malignancy During Flexible Bronchoscopy

Rami Jambeih, MD; Ross Michel, MD; Gary Kinasewitz, MD; Jean Keddissi, MD; Kellie Jones, MD; Kar-Ming Fung, PhD
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University of Oklahoma Health Sciences Center, Oklahoma City, OK


Chest. 2013;144(4_MeetingAbstracts):792A. doi:10.1378/chest.1702905
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Abstract

SESSION TITLE: Bronchoscopic Training and Approaches

SESSION TYPE: Original Investigation Slide

PRESENTED ON: Sunday, October 27, 2013 at 10:45 AM - 11:45 AM

PURPOSE: Optical Coherence Tomography (OCT) uses near-infrared light to generate real-time images of tissues on a microscopic level. OCT technology is used in the assessment of coronary artery lesions, macular degeneration, ulcerative colitis, laryngeal cancer, skin cancer, and tracheal lesions through rigid bronchoscopy. The purpose of the study is to demonstrate the feasibility of OCT as adjunctive imaging modality for the diagnosis of lung malignancies during flexible bronchoscopy.

METHODS: Patients with endobronchial masses accessible by flexible bronchoscopy with no contraindications for bronchoscopy were included in the study. Each patient had 6 OCT images of the endobronchial lesion and 6 control images of a normal appearing bronchial mucosa. Following OCT imaging, 6 biopsies of the endobronchial mass and 6 control biopsies of the imaged normal-appearing area were performed.

RESULTS: 16 patients were enrolled. Lesions included squamous cell carcinoma (5), small cell carcinoma (5), adenocarcinoma (3), neuroendocrine carcinoma (1), B-cell lymphoma (1) and benign schwannoma (1). The first 5 cases were previously described (CHEST 2010; 138(4):984-988). The OCT protocol was able to be completed successfully in 12 patients. In 2 cases, probe malfunction prevented successful acquisition of OCT images. In one patient, diffuse mucosal abnormality did not allow imaging of normal mucosa. Biopsy of the normal mucosa in 1 patient was unable to be interpreted due to technical complications. In the 12 evaluable patients, the normal mucosa revealed a clear demarcation of the epithelium, lamina propria, and cartilage, with preserved and well identified microstructures. Malignant lesions were generally characterized by distortion of the normal architecture and/or irregular ragged dark lines (optical fracture). There were no features favoring the different types of lung malignancies. Overall, the procedures were well tolerated.

CONCLUSIONS: This preliminary report suggests that OCT may have an adjunctive role in the identification of malignant endobronchial lesions. Further studies are needed to better define its role in the evaluation of malignant and non-malignant endobronchial diseases.

CLINICAL IMPLICATIONS: OCT may become a helpful adjunct in directing the bronchoscopist to areas of lung malignancy for biopsy. This technique may also be helpful in identifying malignancy in patients who have contraindications for invasive biopsies.

DISCLOSURE: The following authors have nothing to disclose: Rami Jambeih, Ross Michel, Gary Kinasewitz, Jean Keddissi, Kellie Jones, Kar-Ming Fung

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