Optical Coherence Tomography (OCT) is a relatively new medical imaging device that provides high-resolution and real-time visualization of biological tissues. Initially designed for ophthalmology, OCT is now being applied in other types of pathologies, like cancer diagnosis. This review highlights its impact on disease diagnosis, biopsy guidance, and treatment monitoring. Despite its advantages, OCT has limitations, particularly in tissue penetration and differentiating between malignant and benign lesions. To overcome these challenges, the integration of nanoparticles has emerged as a transformative approach, which significantly enhances contrast and tumor vascularization at the molecular level. Gold and superparamagnetic iron oxide nanoparticles, for instance, have demonstrated great potential in increasing OCT’s diagnostic accuracy through enhanced optical scattering and targeted biomarker detection. Beyond these innovations, integrating OCT with multimodal imaging methods, including magnetic resonance imaging (MRI), positron emission tomography (PET), and ultrasound, offers a more comprehensive approach to disease assessment, particularly in oncology. Additionally, advances in artificial intelligence (AI) and biosensors have further expanded OCT’s capabilities, enabling real-time tumor characterization and optimizing surgical precision. However, despite these advancements, clinical adoption still faces several hurdles. Issues related to nanoparticle biocompatibility, regulatory approvals, and standardization need to be addressed. Moving forward, research should focus on refining nanoparticle technology, improving AI-driven image analysis, and ensuring broader accessibility to OCT-guided diagnostics. By tackling these challenges, OCT could become an essential tool in precision medicine, facilitating early disease detection, real-time monitoring, and personalized treatment for improved patient outcomes.

Optical Coherence Tomography (OCT) is a relatively new medical imaging device that provides high-resolution and real-time visualization of biological tissues. Initially designed for ophthalmology, OCT is starting to be applied in other types of pathologies, like cancer diagnosis. This review highlights its impact on disease diagnosis, biopsy guidance, and treatment monitoring. Despite its advantages, OCT has limitations, particularly in tissue penetration and differentiating between malignant and benign lesions. To overcome these challenges, the integration of nanoparticles has emerged as a transformative approach, which significantly enhances contrast and tumor vascularization at the molecular level. Gold and superparamagnetic iron oxide nanoparticles, for instance, have demonstrated great potential in increasing OCT’s diagnostic accuracy through enhanced optical scattering and targeted biomarker detection. Beyond these innovations, integrating OCT with multimodal imaging methods, including magnetic resonance imaging (MRI), positron emission tomography (PET), and ultrasound, offers a more comprehensive approach to disease assessment, particularly in oncology. Additionally, advances in Artificial Intelligence (AI) and biosensors have further expanded OCT’s capabilities, enabling real-time tumor characterization and optimizing surgical precision. However, despite these advancements, clinical adoption still faces several hurdles. Issues related to nanoparticle biocompatibility, regulatory approvals, and standardization need to be addressed. Moving forward, research should focus on refining nanoparticle technology, improving AI-driven image analysis, and ensuring broader accessibility to OCT-guided diagnostics. By tackling these challenges, OCT could become an essential tool in precision medicine, facilitating early disease detection, real-time monitoring, and personalized treatment for improved patient outcomes.