Role of Optical Imaging in Early Cancer Detection and Treatment

In an interaction with India Pharma Outlook, Dr. Ganesh Babu, Head of Clinical and Regulatory Affairs at Carl Zeiss India, discusses how optical imaging technologies like fluorescence imaging and OCT are revolutionizing cancer detection. He highlights local innovation, AI-driven platforms, and how precision imaging is enhancing diagnostic accuracy and access, especially in underserved regions across India. Dr. Ganesh Babu is a seasoned clinical research and regulatory expert with deep expertise in AI-based medical devices, global compliance frameworks, and digital health innovation. He has led clinical development, regulatory strategy, and KOL engagement across ophthalmology, oncology, CNS, and medical device sectors globally.

With rising demand for noninvasive, real-time cancer diagnostics, how are optical imaging techniques advancing early detection and targeted treatment across clinical applications?

Optical imaging, encompassing a suite of advanced techniques utilizing visible, near-infrared, or ultraviolet light, plays an increasingly pivotal role in early detection and precise treatment of cancer. Modalities such as Fluorescence Imaging, Confocal Laser Endomicroscopy (CLE), Optical Coherence Tomography (OCT), Photoacoustic Imaging (PAI), and Diffuse Optical Tomography (DOT offer significant advantages.

These include their noninvasive nature, enabling real-time tissue visualization without surgical biopsy, and their capacity for high specificity and sensitivity, particularly when integrated with molecular probes. This technological capability facilitates guided interventions, allowing for accurate identification of tumor margins during surgical procedures and targeted visualization of specific biomarkers to detect cancer at its nascent molecular stages.

Key clinical applications highlight its utility. CLE is instrumental in detecting dysplasia in gastrointestinal cancers, as exemplified in Barrett's esophagus. Oral cancers benefit from autofluorescence imaging for distinguishing malignant lesions, while OCT aids in differentiating benign from malignant microstructures in breast cancer. Confocal microscopy provides cellular-level detail for visualizing skin cancers, such as melanomas.

Beyond diagnosis, optical imaging is integral to treatment strategies by enabling real-time monitoring of tumor response to chemotherapy or radiation, enhancing surgical guidance through improved tumor margin detection during resections, and facilitating minimally invasive therapies like photodynamic therapy (PDT) for targeted treatment delivery.

With rising cancer cases in India, early detection through noninvasive methods is becoming urgent. How is optical imaging currently reshaping early diagnostics in Indian oncology?

Optical imaging is revolutionizing cancer care in India by accelerating diagnosis and improving patient outcomes. Leading centers like AIIMS and Tata Memorial routinely use indocyanine green fluorescence during surgery to precisely visualize tumor margins, significantly reducing re-operation rates. Beyond surgery, innovative Indian solutions are transforming population screening. NIRAMAI's portable AI-powered thermal camera has screened over 100,000 women for early breast lesions without radiation. At the same time, IIT-Kanpur's "Munh Parikshak" offers a rapid, cost-effective fluorescence scope for oral cancer triage in field clinics. Telangana's cloud-AI dashboard, which streams optical images from district screenings for specialist review, addresses the shortage of oncologists. These indigenous, AI-integrated innovations are shifting India's cancer care from late, biopsy-led confirmation to swift, community-level triage, enabling earlier treatment and better prognoses.

Optical imaging provides high-resolution views of tissue structures at the cellular level. Which clinical specialties in India are seeing early adoption for cancer detection?

In India, the early adoption of optical imaging notably advances cancer diagnostics across five key specialties, integrating cutting-edge technology into advanced hospitals and community screening initiatives.

Key Specialties Embracing Optical Imaging

Gastroenterology: Tertiary care centers are now incorporating probe-based confocal laser endomicroscopy into their standard workups for conditions like Barrett's esophagus and early gastric cancer. This allows for highly detailed, real-time microscopic examination of tissue.

Breast Oncology: Leading institutions like Tata Memorial are leveraging AI-driven thermal cameras like NIRAMAI's Thermalytix for large-scale breast cancer screenings. Furthermore, indocyanine-green (ICG) fluorescence is routinely used during lumpectomies to guide surgeons in achieving clear margins, thereby reducing re-operation rates.

Oral Oncology/Dentistry: The IIT-Kanpur's handheld fluorescence scope, "Munh Parikshak," is invaluable in community camps and dental clinics. This portable device offers a quick, two-minute triage for suspicious oral lesions, significantly streamlining early detection efforts.

Gynecologic Oncology: The specialty is seeing the introduction of portable "pocket colposcopes" and low-cost OCT devices into cervical cancer field trials. These tools are poised to revolutionize screening in primary healthcare clinics, making advanced diagnostics more accessible.

Head and Neck Surgical Oncology: ICG fluorescence imaging has become a widely adopted intra-operative technique. It's crucial for precisely delineating tumor margins, ensuring more complete resections, and improving patient outcomes in complex head and neck surgeries.

These advancements underscore how optical imaging is rapidly gaining traction in India. Providing high-resolution, real-time feedback enables medical professionals across these diverse clinical specialties to detect malignancies earlier than conventional methods, ultimately improving the efficacy of cancer treatment.

Real-time optical imaging during biopsies and surgeries improves treatment precision. How are Indian hospitals integrating it into diagnostic and surgical workflows?

Indian medical centers are increasingly integrating optical imaging into routine clinical workflows. For instance, Tata Memorial's colorectal and breast units use indocyanine-green (ICG) fluorescence during laparoscopic procedures for real-time assessment of bowel perfusion and tumor margins, a practice documented to reduce complications. In GI endoscopy, probe-based confocal laser endomicroscopy (CLE) allows for "virtual biopsies," significantly improving diagnostic accuracy and accelerating histology turnaround, as shown by a 2023 South Asia study.

Head-and-neck surgical teams across India also utilize ICG-guided resections, with evidence suggesting enhanced margin clearance and progression-free survival. States like Telangana are piloting cloud-AI dashboards to review optical images from district screenings, enabling specialists to identify and refer patients for timely biopsy or surgery efficiently. This integration of live optical feedback across specialties creates a more efficient diagnostic therapy loop, leading to fewer repeat procedures and reduced complication risks.

Rural and tier-2 oncology centers face cost and infrastructure challenges. What are the key barriers to expanding optical imaging access in underserved regions?

The primary hurdles to widespread optical imaging adoption in India are logistical, not technological. High upfront costs (over Rs 25 lakh) and expensive maintenance limit deployment, especially in rural areas. A significant workforce gap exists, with a 2024 survey revealing only one in 15 rural PHCs had staff trained in advanced imaging.

Fragile infrastructure, including unreliable power and connectivity, further constrains community-level screenings. Supply chain delays for spares and unclear insurance reimbursement make optical imaging a "nice-to-have" rather than essential for many tier-2 centers. Without addressing capital subsidies, localized training, and service hubs for rural and tier-2 regions, advanced optical technology will remain confined to metro hospitals, hindering early detection where it's most crucial.

Fluorescence and optical coherence imaging are being explored for higher accuracy. How effective are these combinations proving in India's early cancer detection efforts?

Early Indian trials demonstrate that combining fluorescence "red-flagging" with high-resolution Optical Coherence Tomography (OCT) micro-scans significantly boosts diagnostic accuracy. For oral cancer, a Delhi AIIMS–IIT team's smartphone-sized multimodal device, which first maps autofluorescence and then spectroscopically analyzes the same area, achieved 97% overall accuracy with 100% sensitivity in patient trials. Separately, a low-cost OCT prototype used on 232 rural subjects correctly delineated malignant oral tissue with 93% sensitivity and 74% specificity, with fluorescence pre-selection nearly doubling positive predictive value in follow-up. A 2025 *Scientific Reports* study further refined this, integrating a handheld fluorescence scope with on-device AI for lesion triage before OCT, achieving 95-100% classification accuracy across normal, dysplasia, and OSCC categories. These results suggest the fluorescence-guided OCT combination provides biopsy-like certainty at the point of care, particularly for oral and cervical cancer screenings, enabling rapid, on-the-spot referral, treatment, or reassurance decisions.

AI-driven optical imaging is gaining momentum in cancer diagnostics globally. How could AI enhance early cancer screening and personalized imaging strategies in India over the next decade?

Over the next decade, AI will transform India's optical imaging from diagnostic tools into comprehensive "screen-decide-personalize" platforms. Cloud-based AI models, like NIRAMAI's Thermalytix, already categorize breast thermal images into risk tiers, reducing radiologist workload by 60% and personalizing recall intervals in programs like Punjab's. Telangana's pilot, streaming oral, breast, and cervical images from district camps to an AI dashboard for flagged-case review, offers a blueprint for scaling specialist expertise.

Embedded edge chips in devices like IIT-Kanpur's "Munh Parikshak" will soon provide instant, on-probe AI reads in rural clinics without broadband. Complementing this, IIT-Madras' Bharat Cancer Genome Atlas and AI tools like PIVOT aim to integrate imaging with Indian-specific genomics, enabling personalized screening schedules and fluorescence probes based on individual molecular risk. These advancements will empower AI to detect cancers earlier and intelligently guide who gets screened, which lesions are biopsied, and how frequently individuals are re-imaged, optimizing scarce oncology resources for India's vast population.