Introduction: The diagnostic value of bronchoscopy for peripheral pulmonary lesions (PPLs) has improved since the application of radial endobronchial ultrasound (R-EBUS). Though R-EBUS indicates the position of the PPL, there is often a discrepancy between the obtained R-EBUS image and the diagnostic outcome. Meanwhile, probe based confocal laser endomicroscopy (pCLE) is a novel technique which provides in vivo real-time image of the contacted surface structures. However, its findings have not been established yet.
Methods: Consecutive patients who have underwent bronchoscopy for PPLs were prospectively enrolled. R-EBUS with a guide sheath (GS) was inserted to the target PPL under X-ray fluoroscopic guidance. When an adequate R-EBUS image (within or adjacent to) was obtained, pCLE was sequentially inserted through the GS. Then pCLE image was scanned and biopsy was performed where an abnormal finding was estimated. The pCLE findings of PPLs and the background were recorded and analyzed exploratorily.
Results: We analyzed 19 cases that we could get appropriate tissues. In all cases, bronchial walls showed longitudinal elastic fibers whereas alveolar walls formed grid-like elastic fiber networks. Conversely, discontinuous, crushed or aggregated alveolar structures accompanied by thickened and distorted fibers were detected in PPLs. Some cases showed dark hollow with fragmented or granular fluorescence. On the other hand, 11 cases (57.9%) indicated normal elastic fibers and needed the position change (3 cases; approached other bronchus, 6 cases; adjusted the position, 2 cases; penetrated the covered bronchial wall).
Conclusion: The pCLE has a potential to improve the efficacy of diagnostic bronchoscopy for PPLs.
Yuji Matsumoto, Takehiro Izumo, Yoshihisa Hiraishi, and Takaaki Tsuchida, "A prospective cohort study: probe based confocal laser endomicroscopy for peripheral pulmonary lesions (Conference Presentation)," Proc. SPIE 9691, Endoscopic Microscopy XI; and Optical Techniques in Pulmonary Medicine III, 96910C (Presented at SPIE BiOS: February 14, 2016; Published: 27 April 2016); https://doi.org/10.1117/12.2213736.4828146978001.
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