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Feasibility of Applying Real-time Optical Imaging During Bronchoscopic Interventions for Central Airway Obstruction

Williamson, Jonathan P. MBBS* †; McLaughlin, Robert A. PhD; Phillips, Martin J. MBBS§; Curatolo, Andrea MSc; Armstrong, Julian J. PhD; Maddison, Kathleen J. BSc; Sheehan, Ramon E. MBChB; Sampson, David D. PhD; Hillman, David R. MBBS* ∥; Eastwood, Peter R. PhD* † ∥

Journal of Bronchology & Interventional Pulmonology: October 2010 - Volume 17 - Issue 4 - pp 307-316
doi: 10.1097/LBR.0b013e3181f9eaae
Original Investigations

Background: Interventional bronchoscopists manage central airway obstruction (CAO) through dilation, tumor ablation, and/or stent insertion. Anatomical optical coherence tomography (aOCT), a validated light-based imaging technique, has the unique capacity of providing bronchoscopists with intraprocedural central airway measurements. This study aims to describe the potential role of real-time aOCT in guiding interventions during CAO procedures.

Methods: Prospective case series were recruited from patients referred for bronchoscopic management of symptomatic CAO. Preprocedure chest computed tomography (CT) scans were analyzed for relevant airway dimensions, such as stenosis caliber and length, and aided procedure planning. During bronchoscopy, an aOCT fiberoptic probe was inserted through the working channel of the bronchoscope to image the airway stenosis. From these aOCT images, stenosis dimensions were measured and compared with the preprocedure CT measurements. Preprocedure and postprocedure spirometry, Medical Research Council dyspnea score, and Eastern Cooperative Oncology Group performance status were collected to assess intervention efficacy.

Results: Fourteen patients were studied. CT and aOCT-based measurements of airway caliber and length correlated closely (r2=0.87, P<0.001). Bland-Altman analysis showed strong agreement between measurements (mean difference 0.4±8.6 mm). The real-time nature of aOCT imaging provided the advantage of more up-to-date measurements where a delay occurred between CT and bronchoscopy or where the quality of the CT image was suboptimal. After bronchoscopy, the predicted forced expiratory flow in 1 second increased from 67±26% to 78±19% (P=0.04). Eastern Cooperative Oncology Group and dyspnea scores improved in 83% and 75% of the patients, respectively.

Conclusions: aOCT provides real-time measurements of obstructing central airway lesions that can assist therapeutic interventions such as selection of endobronchial stents and airway dilatation procedures.

Departments of *Pulmonary Physiology

§Respiratory Medicine

Radiology, Sir Charles Gairdner Hospital

School of Anatomy and Human Biology

Optical+Biomedical Engineering Laboratory, School of Electrical, Electronic and Computer Engineering, The University of Western Australia

West Australian Sleep Disorders Research Institute, Perth, Australia

This research has been supported by an Australian National Health and Medical Research Council (NHMRC) Project Grant No. 513854. Jonathan P. Williamson is funded by an NHMRC Postgraduate Research Scholarship No. 463926, a Sir Charles Gairdner Hospital Research Grant, and a University of Western Australia top-up grant. Peter R. Eastwood is funded by an NHMRC Senior Research Fellowship No. 513704. Robert A. McLaughlin is funded by the Raine Medical Research Foundation.

Reprints: Jonathan P. Williamson, MBBS, Department of Respiratory Medicine, Liverpool Hospital, Sydney 2170, Australia (e-mail: jonathan.williamson@sswahs.nsw.gov.au).

Received for publication May 8, 2010; accepted August 28, 2010

Disclosures: Jonathan P. Williamson, Robert A. McLaughlin, Martin J. Phillips, Julian J. Armstrong, David D. Sampson, David R. Hillman, and Peter R. Eastwood are listed as inventors on a provisional patent application associated with clinical applications of anatomical optical coherence tomography. Andrea Curatolo, Kathleen J. Maddison, and Ramon E. Sheehan have no competing interests to declare.

© 2010 Lippincott Williams & Wilkins, Inc.