In this article, the authors focus on optical technologies that have the potential to dramatically improve the detection and classification of epithelial precancers and cancers. Epithelial precancers are associated with a variety of morphologic and molecular changes, which currently can only be assessed through invasive, painful biopsy and subsequent histologic analysis. In addition to visual inspection and histology, a growing number of optical techniques are being applied to the detection of precancerous changes
in vivo
without the need for biopsy, and may serve as diagnostic tools in the future as diagnostic algorithms are further developed. Optical technologies are ideally suited to detect cancer‐related changes because they can noninvasively detect biochemical and morphologic changes with subcellular resolution throughout the entire epithelial thickness. With optical technologies, diagnosis can be achieved in real time using automated techniques.
This article reviews recent developments in reflectance and fluorescence spectroscopy, reflectance and fluorescence confocal microscopy, optical coherence tomography, and optical coherence microscopy. For each emerging technology, the basic principles and the current and potential applications in early cancer detection and diagnosis are reviewed. The potential of optical molecular imaging using exogenous contrast agents to enhance molecular features within tissue that are important for precancer and cancer diagnosis are also reviewed. Finally, future improvements needed to advance optical technologies into widespread clinical use for precancer detection and diagnostic classification are outlined.