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Review
. 2021 Mar 25;57(3):2002537.
doi: 10.1183/13993003.02537-2020. Print 2021 Mar.

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

Susan Fernandes  1 , Gareth Williams  1 , Elvira Williams  1 , Katjana Ehrlich  1 , James Stone  1   2 , Neil Finlayson  1   3 , Mark Bradley  1   4 , Robert R Thomson  1   5 , Ahsan R Akram  1 , Kevin Dhaliwal  1
Affiliations
Review

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

Susan Fernandes et al. Eur Respir J. .

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.

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Conflict of interest statement

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

Figures

FIGURE 1
FIGURE 1
Computed tomography images of different types of solitary pulmonary nodules.
FIGURE 2
FIGURE 2
a) The delivery of fibre-based optical endomicroscopy (OEM), in conjunction with navigational bronchoscopy, to access a distal solitary pulmonary nodule (SPN) in the clinical setting. Computed tomography (CT) and OEM images from an individual patient presenting with an SPN: b) CT demonstrating solid SPN; c) OEM image demonstrating surrounding healthy elastin structure; d) OEM image demonstrating distorted, abnormal elastin structure within the SPN (subsequently confirmed as benign on histopathological analysis) [35].
FIGURE 3
FIGURE 3
Overview of optical fibre-based technologies, delivered via the working channel of a bronchoscope to access and characterise a solitary pulmonary nodule.
See this image and copyright information in PMC

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