Optical Coherence Tomography Offers Noninvasive Way to Visualize Tissues of the Larynx: This emerging technology could improve testing for laryngeal cancers

We are trying to identify and characterize both normal and pathological structures and we are still in the early stages in terms of optimizing the equipment in terms of ergonomics, of being able to use it in a non-invasive manner, and in terms of miniaturization. – -William B. Armstrong, MD

State of Present Research

At the present time, Dr. Wong said, one cannot go out and buy an OCT machine for use in body sites apart from the retina and the skin. OCT for the tissues of the head and neck is still an investigational technology-but is an extremely active area of interest in research in optical diagnostic technology.

There is no competition at this time for a non-invasive high-resolution imaging technique, he added, so in my opinion it is a matter of time, dictated largely by the demonstration of the value of this technology and obviously you would have to convince third-party payers that this is something that should be reimbursed. Convincing third-party payers can be very difficult, he added, as demonstrated by the relatively slow adoption of PET scanning, for example, which took 20 years to get reimbursed by Medicare. But we feel that this technology can make the same impact in medicine for superficial disease in thin structures as PET scanning has for localization of functional differences in tissue metabolism.

The research being done at UC-Irvine includes examination of the pediatric airway, looking at subglottic stenosis, designing devices for use with flexible endoscopy, and designing devices for use with surgical microscopes. The focus has been on instrumentation and nanotechnology applications, Dr. Wong said.

We’ve been able to see the morphology of Reinke’s edema, Dr. Wong added. We are seeing discrete fluid pockets in Reinke’s edema as described by pathologists a hundred years ago and it is fascinating to see these in vivo.

Dr. Wong’s clinical research protocol is not using OCT to alter patient care at this time-the goal is to determine the efficacy of this technology.

We are still at the stage where we are trying to learn the capabilities of the equipment, Dr. Armstrong said.

Limitations

There are limitations for the OCT procedure, Dr. Wong said. The tissue viewed must be a thin structure. There is a trade-off in all imaging technologies where one has to sacrifice resolution for depth of penetration or imaging-so the higher the resolution in general, the less deep you can visualize the tissue-on the other hand, getting information with respect to depth usually results in a loss of resolution.