Physician Investigator (Cl) Pathology, Mass General Research Institute

Associate Professor of Pathology Harvard Medical School

Associate Pathologist Pathology, Massachusetts General Hospital

M.D.; Ph.D. University of Arizona College of Medicine 2009

alveolitis extrinsic allergic; bronchoscopy; lasers; lung; lung cancer; lung cancer prevention; lung diseases; optics and photonics; pneumonia; silicones; spectrometry fluorescence; tomography; tomography optical coherence

Early, accurate diagnosis of lung cancer is fundamental to improving patient survival. Tissue biopsy is key to early diagnosis in order to determine if a lung nodule is malignant or benign. Unfortunately, low-risk methods of biopsy, such as bronchoscopy, are often not able to adequately sample targeted nodules when they are small and/or difficult to navigate to. If a diagnosis cannot be made, patients must undergo repeat biopsy or even surgery, which increases risk and delays diagnosis and therapy.

This project aims to dramatically improve lung cancer diagnosis on low-risk biopsy using cutting-edge optical imaging tools in combination with navigation techniques to provide (1) real-time, intra-procedural assessment of biopsy site locations to ensure adequate tissue sampling and (2) large-volume “virtual optical biopsy” of nodules for diagnosis as a complement to tissue biopsy. This project will result in a powerful new bronchoscopy tool that could reduce unnecessary risky procedures, eliminate delays in diagnosis, and allow earlier therapy initiation.

TECHNICAL ABSTRACT

Inadequate biopsy yield is a significant limitation to early lung cancer diagnosis and is a two-pronged problem: (1) Early-stage lung cancers are not adequately targeted during biopsy due to their small size and (2) even if a nodule is adequately targeted, often there is insufficient tumor in the biopsy to make a definitive diagnosis and/or accomplish all diagnostic testing for patient care.

Optical coherence tomography (OCT) is a high-resolution imaging modality that provides virtual visualization of tissue volumes orders of magnitude larger than biopsy without tissue removal. Dr. Hariri’s group has developed OCT catheters compatible with standard bronchoscopes and demonstrated that OCT can identify lung nodules and assess pathologic features of lung cancer with high sensitivity/specificity.

This project’s aims are to dramatically improve diagnostic capability in lung cancer using large volume OCT to provide (1) virtual intra-procedural evaluation in real-time (VIPER) of biopsy site location and 2) large volume virtual optical biopsy for subsequent pathology diagnosis as a complement to tissue biopsy.

In Aim 1, they will assess if in vivo OCT VIPER biopsy assessment increases tumor yield on bronchoscopic biopsy in a powered, blinded clinical study. In Aim 2, they will use the data obtained in Aim 1 to determine the diagnostic accuracy of large volume OCT optical biopsy with tissue biopsy as compared to tissue biopsy alone. This project will result in clinical translation of a powerful, robust new optical bronchoscopy tool that could reduce unnecessary diagnostic procedures, eliminate delayed diagnoses, provide earlier intervention, and improve patient morbidity/mortality.