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Bonhomme O, Heinen V, Louis R, Corhay JL, Duysinx B. [Probe based confocal laser endomicroscopy in thoracic endoscopy]. Rev Mal Respir 2024; 41:145-155. [PMID: 38030554 DOI: 10.1016/j.rmr.2023.11.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2023] [Accepted: 10/10/2023] [Indexed: 12/01/2023]
Abstract
INTRODUCTION Probe based confocal laser endomicroscopy (pCLE) is a new endoscopic imaging technology. It uses mini probes which can be introduced through the working channels of endoscopes. Whenever applied on the tissue of interest, they allow imaging of tissue at a cellular level. STATE OF ART In the filed of pleuropulmonary malignancies, pCLE showed mostly its ability to guide biopsies samplings. Those results need to be validated in larger prospective studies. In interstitial lung diseases, pCLE provides information complementary to other clinical and paraclinical data. The valuability of these informations need to be investigated further, prospectively in randomized trials. In obstructive pulmonary diseases, pCLE is able to investigate the structural and functional relationships between pulmonary structures. pCLE showed good ability in the identification of acute cellular rejection after lung transplantation. PERSPECTIVES AND CONCLUSION For the time being, pCLE is not part of routine clinical practice. The data available need to be validated in larger randomized prospective trials, before it can be recommended as a guiding tool for biopsies or as a diagnostic tool for pathologic process. New fluorophores are now available. They are specific of some molecular sequences, allowing the enhancement of specific targets within the sample studied.
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Affiliation(s)
- O Bonhomme
- Pneumologues, CHU de Liège, 4000 Liège, Belgique.
| | - V Heinen
- Pneumologues, CHU de Liège, 4000 Liège, Belgique
| | - R Louis
- Pneumologues, CHU de Liège, 4000 Liège, Belgique
| | - J-L Corhay
- Pneumologues, CHU de Liège, 4000 Liège, Belgique
| | - B Duysinx
- Pneumologues, CHU de Liège, 4000 Liège, Belgique
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Tian S, Huang H, Zhang Y, Shi H, Dong Y, Zhang W, Bai C. The role of confocal laser endomicroscopy in pulmonary medicine. Eur Respir Rev 2023; 32:32/167/220185. [PMID: 36697210 PMCID: PMC9879334 DOI: 10.1183/16000617.0185-2022] [Citation(s) in RCA: 13] [Impact Index Per Article: 13.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2022] [Accepted: 11/21/2022] [Indexed: 01/26/2023] Open
Abstract
Accurate diagnosis and subsequent therapeutic options in pulmonary diseases mainly rely on imaging methods and histological assessment. However, imaging examinations are hampered by the limited spatial resolution of images and most procedures that are related to histological assessment are invasive with associated complications. As a result, a high-resolution imaging technology - confocal laser endomicroscopy (CLE), which is at the forefront and enables real-time microscopic visualisation of the morphologies and architectures of tissues or cells - has been developed to resolve the clinical dilemma pertaining to current techniques. The current evidence has shown that CLE has the potential to facilitate advanced diagnostic capabilities, to monitor and to aid the tailored treatment regime for patients with pulmonary diseases, as well as to expand the horizon for unravelling the mechanism and therapeutic targets of pulmonary diseases. In the future, if CLE can be combined with artificial intelligence, early, rapid and accurate diagnosis will be achieved through identifying the images automatically. As promising as this technique may be, further investigations are required before it can enter routine clinical practice.
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Affiliation(s)
- Sen Tian
- Department of Respiratory and Critical Care Medicine, The First Affiliated Hospital of Naval Medical University, Shanghai, China,These authors contributed equally to this work
| | - Haidong Huang
- Department of Respiratory and Critical Care Medicine, The First Affiliated Hospital of Naval Medical University, Shanghai, China,These authors contributed equally to this work
| | - Yifei Zhang
- Department of Respiratory and Critical Care Medicine, The First Affiliated Hospital of Naval Medical University, Shanghai, China,Department of Biomedical Engineering, University of Shanghai for Science and Technology, Shanghai, China,These authors contributed equally to this work
| | - Hui Shi
- Department of Respiratory and Critical Care Medicine, The First Affiliated Hospital of Naval Medical University, Shanghai, China
| | - Yuchao Dong
- Department of Respiratory and Critical Care Medicine, The First Affiliated Hospital of Naval Medical University, Shanghai, China
| | - Wei Zhang
- Department of Respiratory and Critical Care Medicine, The First Affiliated Hospital of Naval Medical University, Shanghai, China
| | - Chong Bai
- Department of Respiratory and Critical Care Medicine, The First Affiliated Hospital of Naval Medical University, Shanghai, China,Department of Biomedical Engineering, University of Shanghai for Science and Technology, Shanghai, China,Corresponding author: Chong Bai ()
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Goorsenberg A, Kalverda KA, Annema J, Bonta P. Advances in Optical Coherence Tomography and Confocal Laser Endomicroscopy in Pulmonary Diseases. Respiration 2019; 99:190-205. [PMID: 31593955 DOI: 10.1159/000503261] [Citation(s) in RCA: 30] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2019] [Accepted: 09/05/2019] [Indexed: 12/13/2022] Open
Abstract
Diagnosing and monitoring pulmonary diseases is highly dependent on imaging, physiological function tests and tissue sampling. Optical coherence tomography (OCT) and confocal laser endomicroscopy (CLE) are novel imaging techniques with near-microscopic resolution that can be easily and safely combined with conventional bronchoscopy. Disease-related pulmonary anatomical compartments can be visualized, real time, using these techniques. In obstructive lung diseases, airway wall layers and related structural remodelling can be identified and quantified. In malignant lung disease, normal and malignant areas of the central airways, lung parenchyma, lymph nodes and pleura can be discriminated. A growing number of interstitial lung diseases (ILDs) have been visualized using OCT or CLE. Several ILD-associated structural changes can be imaged: fibrosis, cellular infiltration, bronchi(ol)ectasis, cysts and microscopic honeycombing. Although not yet implemented in clinical practice, OCT and CLE have the potential to improve detection and monitoring pulmonary diseases and can contribute in unravelling the pathophysiology of disease and mechanism of action of novel treatments. Indeed, assessment of the airway wall layers with OCT might be helpful when evaluating treatments targeting airway remodelling. By visualizing individual malignant cells, CLE has the potential as a real-time lung cancer detection tool. In the future, both techniques could be combined with laser-enhanced fluorescent-labelled tracer detection. This review discusses the value of OCT and CLE in pulmonary medicine by summarizing the current evidence and elaborating on future perspectives.
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Affiliation(s)
- Annika Goorsenberg
- Department of Pulmonology, Amsterdam University Medical Centers, University of Amsterdam, Amsterdam, The Netherlands,
| | - Kirsten A Kalverda
- Department of Pulmonology, Amsterdam University Medical Centers, University of Amsterdam, Amsterdam, The Netherlands
| | - Jouke Annema
- Department of Pulmonology, Amsterdam University Medical Centers, University of Amsterdam, Amsterdam, The Netherlands
| | - Peter Bonta
- Department of Pulmonology, Amsterdam University Medical Centers, University of Amsterdam, Amsterdam, The Netherlands
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In vivo endomicroscopic features of distal airways in chronic bronchitis and chronic obstructive pulmonary disease. КЛИНИЧЕСКАЯ ПРАКТИКА 2018. [DOI: 10.17816/clinpract9415-24] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022] Open
Abstract
Relevance: Probe-based confocal laser endomicroscopy (CLE) of distal airways is a unique technology that allows real-time visualization of structures containing natural fluorophores, which are emitted by exposure to laser radiation with a wavelength of 488 nm, in vivo. To date, the endomicroscopic features of the distal respiratory tract have not been adequately studied in lung diseases, including chronic obstructive pulmonary disease and chronic bronchitis.
The goal of the present study is to describe the endomicroscopic signs of the distal parts of the respiratory system in chronic inflammatory lung diseases such as chronic obstructive pulmonary disease and chronic bronchitis.
Methods: A total of 21 patients with emphysematous and bronchitic phenotypes of chronic obstructive pulmonary disease and chronic bronchitis were examined. All the patients have undergone CLE of distal airways or alveoloscopy during bronchoscopy. The most pathognomonic changes were evaluated on the obtained endomicroscopic images.
Results: For each studied nosological form of chronic inflammatory lung diseases, by careful morphometric analysis of a significant number of informative images, the most specific endomicroscopic changes were identified with the release of CLE patterns.
Conclusions: CLE of distal airways in patients with chronic inflammatory lung diseases allows visualizing changes in the elastic framework of the acini, as well as identifying pathological intraluminal contents, which can be attributed to valuable additional tools in a row of diagnostic methods of respiratory medicine.
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Yserbyt J, Dooms C, Janssens W, Verleden GM. Endoscopic advanced imaging of the respiratory tract: exploring probe-based confocal laser endomicroscopy in emphysema. Thorax 2017; 73:188-190. [PMID: 28411249 DOI: 10.1136/thoraxjnl-2016-209746] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2016] [Revised: 03/15/2017] [Accepted: 03/27/2017] [Indexed: 11/04/2022]
Abstract
: Probe-based confocal laser endomicroscopy (pCLE) was performed in 15 patients with emphysema and 15 healthy subjects to visualise small airways in a direct and dynamic way. Morphometry shows that the median cross-sectional area of the alveolar openings at the level of the alveolar ducts is significantly larger in emphysema (7.2×104 µm2) as compared with healthy subjects (5.2×104 µm2) (p=0.0002). Normalised autofluorescence intensity histograms show a decrease in median autofluorescence intensity (mAFI) in emphysema (p=0.001). mAFI correlates well with Tiffeneau index (r=0.66, p=0.007, 95% CI 0.21 to 0.88). Autofluorescence intensity in emphysema correlates with corresponding data of CT-based quantification. pCLE-based morphometry and autofluorescence intensity analysis in emphysema is able to detect regional changes inside the 'quiet zone'. TRIAL REGISTRATION NUMBER Results, NCT01204970.
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Affiliation(s)
- J Yserbyt
- Respiratory Division, Department of Clinical and Experimental Medicine, University Hospitals Leuven, KU Leuven, Belgium
| | - C Dooms
- Respiratory Division, Department of Clinical and Experimental Medicine, University Hospitals Leuven, KU Leuven, Belgium
| | - W Janssens
- Respiratory Division, Department of Clinical and Experimental Medicine, University Hospitals Leuven, KU Leuven, Belgium
| | - G M Verleden
- Respiratory Division, Department of Clinical and Experimental Medicine, University Hospitals Leuven, KU Leuven, Belgium
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Shafiek H, Fiorentino F, Cosio BG, Kersul A, Thiberville L, Gómez C, Riera M, Martín ML, Martínez R, Noguera MA, Agustí A, Sauleda J. Usefulness of Bronchoscopic Probe-Based Confocal Laser Endomicroscopy in the Diagnosis of Pneumocystis jirovecii Pneumonia. Respiration 2016; 92:40-7. [DOI: 10.1159/000447431] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/28/2015] [Accepted: 06/06/2016] [Indexed: 11/19/2022] Open
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Bush A, Pavord I. Year in review 2014. Paediatric and adult clinical studies. Thorax 2015; 70:368-72. [DOI: 10.1136/thoraxjnl-2015-206880] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
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