Optical coherence tomography (OCT) is analogous to ultrasound imaging, except that the imaging is performed using light rather than sound.[
42–
44] By measuring the echo time delay and intensity of back-reflected light, OCT can reveal tissue microstructure with micron-level resolution and 1-2 mm penetration depth, approaching those of standard excisional biopsy and histopathology, but without the need of tissue removal.[
45–
47] Since the speed of light is much faster than that of sound, the echo delay time in OCT is detected using a technique called low coherence interferometry.[
48–
50] shows a schematic diagram of a Michelson interferometer. OCT uses a broad bandwidth light source; therefore interference signal is only observed when the path lengths of the reference and sample arms are matched to within the coherence length (the length over which the phase of optic wave oscillation is correlated) of the light. By scanning the reference mirror position, the magnitude and echo time delay (equivalent to depth) of the reflected light from the sample can be measured. The optical beam can be scanned across the tissue surface to form 2D or 3D images. The contrast in OCT comes from the difference in light scattering properties in various tissue layers, and as a result, OCT can reveal tissue microstructure without the use of contrast agents (i.e., label-free imaging).
The axial resolution of OCT is determined by the coherence length of the light source: Dz = (2ln2/pi (pi=3.14159)) (l
2/Dl), where Dl is the full-width-at-half-maximum of the source spectrum (the difference between the two wavelength values at which the power is equal to half of its maximum value) and l is the center wavelength of the source spectrum.[
51] From this equation, broadband light sources can achieve high axial resolution. Typical OCT systems can achieve axial resolutions of ~10-15
μm. More sophisticated broadband light sources can generate a broadband spectrum and hence result in ultrahigh-resolution OCT imaging.[
52,
53] The transverse resolution of OCT is the same as that in optical microscopy, and is determined by the diffraction limit of the focused optical beam: Dx = (4l/pi (pi=3.14159))(f/d), where d is the beam size on the objective lens and f is its focal length (the distance from the lens to the focus spot). Fine transverse resolution can be obtained by using a large numerical aperture (NA) objective that focuses the beam on a small spot size. The combination of a very broad bandwidth light source and Bessel beam[
54–
56] has culminated in the realization of micro-OCT with 1-2
μm isotropic resolution in 3D.[
57]
Optical coherence microscopy (OCM) combines confocal microscopy with OCT to achieve cellular resolution imaging in the en-face plane (the plane parallel to the surface of the sample).[
58–
64] The combination of coherence and confocal gates enhances rejection of unwanted scattered light, thereby allowing improved imaging depth compared to confocal microscopy alone. shows representative OCM images of human colon specimens
ex vivo.[
65] Representative histology images in this figure at the corresponding depth in this figure show good correlation with the OCM images. Detailed structures such as crypt lumens and translucent mucin-containing cells can be clearly visualized. Also shown in this figure is the 3D isosurface view of two central colonic crypts. Various types of organs have been shown to be amenable to
ex vivo study using full-field OCT.[
66] As high-resolution OCT images are able to recapitulate the main histological features in tissues, this technique looks promising in performing fast histology, especially in intraoperative procedures. In addition, OCM has been demonstrated to provide high-resolution images of renal pathology in real time without exogenous contrast medium or histological processing. High sensitivity and specificity was achieved using OCM to differentiate normal from neoplastic renal tissues, suggesting possible applications for guiding renal mass biopsies or evaluating surgical margins.[
67]
Using fiber-optic and micro-optic components, OCT can be integrated with a wide range of imaging devices such as endoscopes, laparoscopes, catheters, and needles to enable imaging inside the body.[
47,
68–
75] Endomicroscopic OCT provides unique advantages for evaluating diseases present within the epithelial surface of hollow organs as well as buried in deep solid organs. Clinical applications of endoscopic OCT/OCM include the detection of pre-malignant lesions, identification of disease below the tissue surface, assessment of depth of tumor invasion, localization of cancer margins, evaluation of effectiveness of therapy, and reduction in the number of biopsies and frequency of surveillance.[
69,
76–
78] shows an example of a forward-viewing OCT imaging needle that can be used for neurosurgery guidance. The OCT image obtained can clearly identify anatomic landmarks that can be used in stereotactic surgery.[
79] Simultaneous OCT and Doppler OCT (DOCT) imaging is also possible. DOCT measures the frequency shift of the back-scattered photons caused by the motion of samples (e.g., red blood cells). This technique has been used to quantify the blood flow velocity in biological samples.[
78]
The development of endoscopic OCT greatly facilitates imaging of certain conditions. For example, OCT has been shown to be successful at detecting intestinal metaplasia in patients with Barrett's esophagus patients[
80–
84] and transmural inflammation in those who have inflammatory bowel disease.[
85] OCT also has the potential to distinguish hyperplastic from adenomatous polyps in the colon.[
86] Of particular interest, is the fact that OCT may be useful in identifying high-grade dysplasia, such as in Barrett's esophagus. However, additional work in this area is still required. Evans
et al. reported a sensitivity of 83% and specificity of 75% for detecting high-grade dysplasia and intramucosal carcinoma with blinded scoring of OCT images from 55 patients.[
87] Isenberg
et al. reported a sensitivity of 68% and a specificity of 82%, with an accuracy of 78% for the detection of dysplasia in biopsies from 33 patients with Barrett's esophagus.[
88] Employing computer-aided diagnosis, Qi
et al. found an increased sensitivity of 82%, a specificity of 74%, and an accuracy of 83% in 13 patients.[
89] It is anticipated that further improvements in spatial resolution will hopefully result in better diagnostic capability.
OCT/OCM can perform high-resolution imaging of tissue structures
in situ and in real time. Images are available immediately without the need for excision and histological processing of a specimen. The development of high-resolution and high-speed OCT technology, as well as OCT endoscopic devices, will soon provide clinicians with more diagnostically relevant information in increasing clinical applications. Potential applications of OCT/OCM in pathology might include enhanced specimen grossing, reduced need for frozen sections during intraoperative consultation,[
90] and direct scanning of tissue blocks to produce 3D histology images, potentially bypassing certain steps involving glass slide workflow.[
91]