Fibre-based Photonic Fingerprinting and Theranostic Ablation of Pulmonary Nodules

Solitary pulmonary nodules are a huge clinical challenge, which cause considerable diagnostic uncertainty as they may represent early treatable lung cancer. The current guidelines advocate a protracted diagnostic pathway involving radiological surveillance. While endobronchial navigation technologies can access the majority of pulmonary nodules, the diagnostic yield from biopsy is suboptimal - cutting-edge technologies are needed to improve the existing care pathway. I propose to develop a novel optical fibre-based approach to delineate pulmonary nodules and perform in situ therapeutic ablation with dynamic feedback of therapeutic efficacy during intervention. Firstly, I will build a fibre-based sensing and therapeutic platform, using a hollow core optical fibre (capable of delivering excitation light with sensing and therapeutic intent), a multicore imaging bundle, and sensitive detectors. Secondly, systematic ex vivo studies using lung cancer tissue resections will be undertaken to identify key features in the optical fingerprint to discriminate abnormal from normal lung tissue (using optical endomicroscopy, fluorescence lifetime-based spectroscopy and laser-induced breakdown spectroscopy), and to characterise the effectiveness of ultrafast laser-based ablation. Finally, I will evaluate a simple steering mechanism to enable navigation across the nodule - the imaging/spectroscopy, laser ablation and steering capabilities will be evaluated in whole ex vivo human lungs embedded with targets to provide near-human assays with airway and distal lung anatomy analogous to in vivo experiments. This work will leverage state of the art optical fibre technology to allow complete ablation of small nodules or selective removal of the extracellular matrix around larger nodules to potentially augment aligned therapies. This approach may enable a one-stop solution for pulmonary nodules, avoiding the need for radiological follow-up and reducing healthcare costs.