Solitary pulmonary nodule imaging approaches and the role of optical fibre-based technologies
- Susan Fernandes1,
- Gareth Williams1,
- Elvira Williams1,
- Katjana Ehrlich1,
- James Stone1,2,
- Neil Finlayson1,3,
- Mark Bradley1,4,
- Robert R. Thomson1,5,
- Ahsan R. Akram1 and
- Kevin Dhaliwal1
- 1Centre for Inflammation Research, Queen's Medical Research Institute, The University of Edinburgh, Edinburgh, United Kingdom
- 2Centre for Photonics and Photonic Materials, Department of Physics, The University of Bath, Bath, United Kingdom
- 3Institute for Integrated Micro and Nano Systems, School of Engineering, The University of Edinburgh, King's Buildings, Edinburgh, United Kingdom
- 4EaStCHEM, The University of Edinburgh, School of Chemistry, Joseph Black Building, King's Buildings, Edinburgh, United Kingdom
- 5Institute of Photonics and Quantum Sciences, David Brewster Building, School of Engineering and Physical Sciences, Heriot-Watt University, Edinburgh, United Kingdom
- Dr Susan Fernandes, Centre for Inflammation Research, Queen's Medical Research Institute, The University of Edinburgh, 47 Little France Crescent, Edinburgh, EH16 4TJ. E-mail: susan.fernandes{at}ed.ac.uk
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.
Footnotes
This manuscript has recently been accepted for publication in the European Respiratory Journal. It is published here in its accepted form prior to copyediting and typesetting by our production team. After these production processes are complete and the authors have approved the resulting proofs, the article will move to the latest issue of the ERJ online. Please open or download the PDF to view this article.
Conflict of interest: Dr. Fernandes reports grants from MRC, grants from Boston Scientific, during the conduct of the study.
Conflict of interest: Dr. Williams reports In addition, Dr. Williams has a patent Planned pending.
Conflict of interest: Dr. Williams reports In addition, Dr. Williams has a patent Planned pending.
Conflict of interest: Dr. Ehrlich has nothing to disclose.
Conflict of interest: Dr. Stone reports grants from EPSRC, grants from Boston Scientific, during the conduct of the study; In addition, Dr. Stone has a patent Imaging Fibre issued.
Conflict of interest: Dr. Finlayson reports grants from EPSRC, during the conduct of the study; other from Prothea-X, outside the submitted work.
Conflict of interest: Dr. Bradley reports grants from MRC, grants from Boston Scientific, grants from EPSRC, during the conduct of the study.
Conflict of interest: Dr. Thomson reports grants from University of Edinburgh (I have an honorary position), during the conduct of the study.
Conflict of interest: Dr. Akram reports grants from academic grants, during the conduct of the study.
Conflict of interest: Dr. Dhaliwal reports grants from MRC, grants from Boston Scientific, grants from EPSRC, other from Mauna Kea Technologies, during the conduct of the study.
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- Received November 25, 2019.
- Accepted September 29, 2020.
- Copyright ©ERS 2020