Current technologies for the detection of cancer lack the sensitivity for early detection at times when therapy would be most effective, and cannot detect minimal residual disease that persists after conventional therapies. Therefore, it will be necessary to develop image-guided approaches for multiplexed molecular characterization of cancer and methods to visualize small numbers of cancer initiating cells. Imaging and sensing will need to move from detection limits of 1 cm to 1 mm, or even 100 μm diameter masses, and new technologies with this sensitivity need to be developed. Optical imaging has the sensitivity for this level of detection and there are a number of recent advances that will enable the use of optics in the clinic for cancer detection. New instruments based on micro-optical designs can be used to reach in the body to reveal microanatomic and molecular detail that are indicators of early cancers. We are advancing the technologies that enable miniaturization of 3-D scanning confocal microscopes and Raman endoscopes to examine tissue in situ for early anatomic and molecular indicators of disease, in real time, and at cellular resolution. These new devices will lead to a shift from the current diagnostic paradigm of biopsy followed by histopathology and recommended therapy, to one of non-invasive point-of-care diagnosis with the possibility of treatment in the same session. By creating the tools for point-of-care pathology we are reducing the time and distance between the patient and the diagnostic event, and changing the practice of medicine. The emerging combinations of instruments and molecular probe strategies will reveal disease states in finer detail and provide greater information to clinicians for more informed, and directed therapies. Personalized medicine is really molecular medicine and the new imaging and diagnostic tools that characterize molecular basis of disease are driving personalized care and early intervention.

© 2016 Optical Society of America

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