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From the Authors: We thank Kalverda and colleagues for their letter regarding our recently published paper [1], and appreciate the opportunity to provide additional clarity on the points that they raise about the work. Below we address the questions asked by Kalverda and colleagues: Enrollment criteria Our primary objective was to conduct a blinded, prospective study to evaluate the diagnostic accuracy of endobronchial OCT (EB-OCT) for microscopic ILD diagnosis as compared to concurrent surgical lung biopsy (SLB) and clinical follow-up diagnosis. Our inclusion criteria were: a) age >21 years, b) fibrotic ILD based on high-resolution computed tomography (HRCT) with unclear ...

To the editor: In 15-30% of patients with a fibrotic interstitial lung disease (ILD) tissue acquisition is indicated as the diagnostic confidence based on clinical and radiological investigations does not justify a specific treatment allocation [1]. However, surgical lung biopsy and transbronchial cryobiopsy are associated with considerable risks of morbidity and even mortality [2]. Minimally invasive imaging techniques have the potential to obviate the need for tissue biopsy in at least a proportion of these patients [3]. Therefore, we are excited by the work of Nandy and colleagues and congratulate them with their work on endobronchial optical coherence tomography (EB-OCT ...

An accurate diagnosis of fibrotic interstitial lung disease (ILD) is critical to inform prognostication and selection of pharmacotherapy. Clinicians are ideally able to integrate the clinical history, laboratory findings, and morphologic features on chest imaging within multidisciplinary discussion (MDD) to achieve a consensus diagnosis. However, despite this process, a confident diagnosis remains elusive in approximately 15% of patients ( 1 ), and there is often a need for additional information to guide management decisions. This diagnostic uncertainty has traditionally prompted consideration of histopathologic evaluation via surgical lung biopsy (SLB), but this procedure is associated with substantial risk of morbidity and mortality ( 2 ...

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Rationale: Early, accurate diagnosis of interstitial lung disease (ILD) informs prognosis and therapy, especially in idiopathic pulmonary fibrosis (IPF). Current diagnostic methods are imperfect. HRCT resolution is limited while surgical lung biopsy (SLB) carries risks of morbidity/mortality. Endobronchial optical coherence tomography (EB-OCT) is a low-risk, bronchoscope-compatible modality that images large lung volumes in vivo with microscopic resolution, including subpleural lung, and has the potential to improve the diagnostic accuracy of bronchoscopy for ILD diagnosis. Objectives: We performed a prospective diagnostic accuracy study of EB-OCT in ILD patients with a low-confidence diagnosis undergoing SLB. Primary endpoints were EB-OCT sensitivity/specificity ...

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Idiopathic pulmonary fibrosis (IPF) is a progress, fatal form of insterstitial lung disease (IDL)....

Rationale: Subglottic edema and acquired subglottic stenosis are potentially airway-compromising sequelae in neonates following endotracheal intubation. At present, no imaging modality is capable of in vivo diagnosis of subepithelial airway wall pathology as signs of intubation-related injury. Objectives: To use Fourier domain long-range optical coherence tomography (LR-OCT) to acquire micrometer-resolution images of the airway wall of intubated neonates in a neonatal intensive care unit setting and to analyze images for histopathology and airway wall thickness. Methods: LR-OCT of the neonatal laryngotracheal airway was performed a total of 94 times on 72 subjects (age, 1–175 d; total intubation, 1–104 ...

Rationale: Adjusting for the amount of smoking, women have a 50% increased risk of COPD compared with men. It is not known what the anatomic basis/mechanism(s) of these sex-related differences in COPD might be. Objective: To characterize the impact of female sex hormones on chronic cigarette smoke-induced airway remodeling and emphysema in a mouse model of COPD. Methods: Airway remodeling and emphysema were determined morphometrically in male, female, and ovariectomized mice exposed to 6 months of cigarette smoke. Antioxidant- and transforming growth factor (TGFβ)-related genes were profiled in airway tissues. The selective estrogen receptor modulator, tamoxifen, was ...

Subglottic edema and acquired subglottic stenosis are potentially airway -compromising sequelae in neonates following endotracheal intubation . At present, no imaging modality is capable of in vivo diagnosis of subepithelial airway wall pathology as signs of intubation - related injury . OBJECTIVES: To use Fourier domain long - range optical coherence tomography (LR-OCT) to acquire micrometer-resolution images of the airway wall of intubated neonates in a neonatal intensive care unit (NICU) setting and to analyze images for histopathology and airway wall thickness. METHODS: LR-OCT of the neonatal laryngotracheal airway was performed a total of 94 times on 72 subjects (age 1-175 days, total intubation ...

Rationale: Lung carcinoma diagnosis on tissue biopsy can be challenging due to insufficient tumor and lack of architectural information. Optical coherence tomography (OCT) is a high-resolution imaging modality that visualizes tissue microarchitecture in volumes orders of magnitude larger than biopsy. It has been proposed that OCT could potentially replace tissue biopsy. Objectives: We aim to determine if OCT could replace histology in diagnosing lung carcinomas . We develop and validate OCT interpretation criteria for common primary lung carcinomas : adenocarcinoma, squamous cell carcinoma (SCC), and poorly differentiated carcinoma . Methods: A total of 82 ex vivo tumor samples were included in a blinded ...

Rationale: The mechanisms underlying cystic fibrosis (CF) lung disease pathogenesis are unknown. Objective: To establish mechanisms linking anion transport with the functional microanatomy, we evaluated normal and CF piglet trachea, as well as adult swine trachea in the presence of selective anion inhibitors. Methods: We investigated airway functional microanatomy using micro-optical coherence tomography, a new imaging modality that concurrently quantifies multiple functional parameters of airway epithelium in a co-localized fashion. Main Results: Tracheal explants from wild type swine demonstrated a direct link between periciliary liquid (PCL) hydration and mucociliary transport (MCT) rates, a relationship frequently invoked but never experimentally confirmed ...

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