Significance With the growing demand for health care and the development of medical examinations, more accurate and minimally invasive diagnosis and treatment technologies have received extensive global attention. Currently, a rapid and effective intraoperative diagnostic method is still lacking for major diseases in clinical practice. Traditional medical imaging modalities, such as magnetic resonance imaging, computed tomography, ultrasound imaging, positron emission tomography, and single-photon emission computed tomography, are commonly used to present the global anatomical structure or functional information of human tissue, but their resolution is too low to show fine structures. Histopathological examination is the gold standard for malignant tumors and other diseases, which detect pathological changes in cells on a microscopic scale with the best accuracy. However, the process is complex and time-consuming and depends on the distribution of biopsy samples; therefore, it cannot cover a wide range of tissues. In addition, diagnosis and treatment procedures are relatively independent, leading to the mismatch of preoperative and intraoperative information, and surgical operations largely depend on the personal experience of surgeons.

Represented by emerging optical imaging and spectroscopic methods, biomedical images at mesoscopic and macroscopic levels provide a good foundation for multimodal rapid and precise diagnosis, such as optical coherence tomography, two-photon microscopy, photoacoustic imaging, Raman spectroscopy and microscopic imaging, and fluorescence spectroscopy and imaging. Because of their excellent real-time performance, high accuracy, and resolution in intraoperative use, many of these methods are known as “optical biopsy”. In terms of treatment, optical methods with high spatio-temporal selectivity, such as laser ablation, photodynamic therapy, and photothermal therapy have gradually entered clinical practice. At the same time, the development of computer vision, precision instruments, automation, and other research fields has promoted more intelligent, accurate, and personalized diagnosis and treatment technology, including artificial intelligence-assisted medical image processing, minimally invasive surgical robots, intelligent treatment planning, and navigation. On this basis, by combining optical imaging and treatment, we can build an intelligent theranostic system, which can break down the barrier between traditional diagnosis and treatment, improving the current surgical process. The accurate intraoperative diagnosis results are directly used for treatment planning and control, which can achieve intelligent, quantitative, and accurate lesion clearance. These emerging technologies are of great significance for the diagnosis and treatment of tumors and other major diseases in clinical practice. Therefore, summarizing the existing studies regarding emerging optical theranostics technologies is necessary to guide the future development and clinical transformation of this field.

Progress In this paper, the research progress of intelligent precise optical diagnosis and therapy technology, specifically for malignant tumor theranostics, is reviewed based on three aspects: 1) optical imaging and intelligent diagnosis methods (Fig. 2); 2) precise optical treatment methods (Fig. 4); 3) optical diagnosis and therapy instruments and theranostic methods (Fig. 6). Through intelligent optical diagnosis, the location of lesions could be automatically determined through computer-aided image processing, and we can plan and control precision optical treatment using theranostic algorithms and hardware systems. There are various optical imaging methods used in clinical or preclinical experiments, and some clinical optical diagnosis standards are established preliminarily. However, most doctors have not been trained to read optical images (or spectra); thus, computer-aided automated or quantitative diagnosis is currently the most appropriate method (example given in Fig. 3), which involves quantitative parameter extraction, machine learning, deep learning, and other methods. We focus on several conventional mainstream optical diagnostic modalities with intelligent diagnostic algorithms, including fluorescence and imaging spectroscopy, Raman spectroscopy and microscopy, optical coherence tomography, and photoacoustic imaging. Then, we describe several emerging optical treatment methods, including laser ablation, photodynamic, photothermal, and other light-activated therapies. Precision theranostic devices and methods are divided into four categories and reviewed: imaging field enlargement, improving image quality, multimodal imaging, and the integration of diagnosis and treatment.

Conclusions and Prospects Optical diagnosis and treatment of major diseases, especially integrated diagnosis and treatment technology, can considerably improve the clinical processes and treatment prognosis. We expect that intelligent, quantitative, and accurate optical diagnosis and treatment technology will play a more significant role in human life and health, promoting the development and progress of clinical diagnosis and treatment of malignant tumors.