Abstract
Although probe-based confocal laser endomicroscopy (pCLE) is on the edge of entering daily practice in gastroenterological endoscopy, findings in the field of respiratory medicine are only rarely reported, keeping pCLE during flexible bronchoscopy as a mere preclinical research tool. Since the endomicroscopic aspects of normal bronchial and alveolar tissue have recently been described, we want to take part in the development of a pCLE glossary, describing the pCLE features of pulmonary pathologies. We recruited among patients referred for diagnostic bronchoscopy for pCLE imaging. Images from the central airways were obtained in every patient and alveoloscopy was performed in at least five sub-segments per patient. Using pCLE imaging, we were able to discriminate normal from abnormal endomicroscopical patterns in four respiratory conditions. These findings were matched with classical histopathology. Reflecting on our own experience using pCLE imaging, we summarise the present state of knowledge, discuss five clinical cases and discuss current limitations and the future promise of this novel imaging tool.
Highlights
Until recently, assessment of pathological conditions in respiratory tissue relied primarily on macroscopic inspection during a bronchoscopic procedure and histopathological examination of subsequent biopsy samples
We recruited among patients referred for diagnostic bronchoscopy for probe-based confocal laser endomicroscopy (pCLE) imaging
Using pCLE imaging, we were able to discriminate normal from abnormal endomicroscopical patterns in four respiratory conditions
Summary
Assessment of pathological conditions in respiratory tissue relied primarily on macroscopic inspection during a bronchoscopic procedure and histopathological examination of subsequent biopsy samples. The inter-observer agreement for in vivo pCLE imaging of both central airways and alveoli was stated to be high for autofluorescence brightness, fair for elastic fibre thickness, and good for alveolar cellularity [4]. This was not the case for the correlation between pCLE imaging and pathological examination of biopsy samples. Data on larger groups of patients stratified by disease severity and distribution undergoing pCLE in a standardised way are lacking. For this reason, we registered a trial under Clinicaltrials.gov, enabling us to recruit a considerable number of patients with conclusive evidence of a respiratory disease, to be subjected to pCLE imaging at the time of their referral for diagnostic bronchoscopy. The cases that are dealt with in this report are merely an attempt to illustrate the current characteristics of the imaging technique and share procedural aspects with other pCLE users
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