[en] 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.
Thiberville, L., Salaün, M., Lachkar, S., et al. Human in vivo fluorescence microimaging of the alveolar ducts and sacs during bronchoscopy. Eur Respir J 33 (2009), 974–985.
Thiberville, L., Moreno-Swirc, S., Vercauteren, T., et al. In Vivo imaging of the bronchial wall microstructure using fibered confocal fluorescence microscopy. Am J Respir Crit Care Med 175 (2007), 22–31.
Yick, C.Y., von der Thüsen, J.H., Bel, E.H., et al. In vivo imaging of the airway wall in asthma: fibered confocal fluorescence microscopy in relation to histology and lung function. Respir Res, 12, 2011, 85.
Yserbyt, J., Dooms, C., Janssens, W., et al. Endoscopic advanced imaging of the respiratory tract: exploring probe-based confocal laser endomicroscopy in emphysema. Thorax 73 (2018), 188–190.
Cosío, B.G., Shafiek, H., Fiorentino, F., et al. Structure-function relationship in COPD revisited: an in vivo microscopy view. Thorax 69 (2014), 724–730.
Wellikoff, A.S., Holladay, R.C., Downie, G.H., et al. Comparison of in vivo probe-based confocal laser endomicroscopy with histopathology in lung cancer: a move toward optical biopsy. Respirology 20 (2015), 967–974.
Shah, P.L., Kemp, S.v, Newton, R.C., et al. Clinical correlation between real-time endocytoscopy, confocal endomicroscopy, and histopathology in the central airways. Respiration 93 (2017), 51–57.
Fuchs, F.S., Zirlik, S., Hildner, K., et al. Confocal laser endomicroscopy for diagnosing lung cancer in vivo. Eur Respir J 41 (2013), 1401–1408.
Wijmans, L., de Bruin, D.M., Meijer, S.L., et al. Needle based confocal laser endomicroscopy for mediastinal lesions, an in vivo pilot-study. In: 14 Interventional Pulmonology [Internet]. Eur Respir J, 2016, OA3015 Available from: https://erj.ersjournals.com/content/48/suppl_60/OA3015.
Wijmans, L., Yared, J., de Bruin, D.M., et al. Needle-based confocal laser endomicroscopy for real-time diagnosing and staging of lung cancer. Eur Respir J, 53, 2019 [1801520].
Hassan, T., Piton, N., Lachkar, S., et al. A novel method for in vivo imaging of solitary lung nodules using navigational bronchoscopy and confocal laser microendoscopy. Lung 193 (2015), 773–778.
Hassan, T., Thiberville, L., Hermant, C., et al. Assessing the feasibility of confocal laser endomicroscopy in solitary pulmonary nodules for different part of the lungs, using either 0.6 or 1.4 mm probes. Hasan B, editor. PLoS One, 12, 2017 [e0189846].
Seth, S., Akram, A.R., McCool, P., et al. Assessing the utility of autofluorescence-based pulmonary optical endomicroscopy to predict the malignant potential of solitary pulmonary nodules in humans. Sci Rep, 6, 2016, 31372.
Kramer, T., Wijmans, L., De Bruin, M., et al. Bronchoscopic needle-based confocal laser endomicroscopy (nCLE) as a real-time detection tool for peripheral lung cancer. Thorax 77 (2022), 370–377.
Manley, C.J., Kramer, T., Kumar, R., et al. Robotic bronchoscopic needle-based confocal laser endomicroscopy to diagnose peripheral lung nodules. Respirology 28 (2023), 475–483.
Han, Y., Kim, H.J., Kong, K.A., et al. Diagnosis of small pulmonary lesions by transbronchial lung biopsy with radial endobronchial ultrasound and virtual bronchoscopic navigation versus CT-guided transthoracic needle biopsy: a systematic review and meta-analysis. PLoS One, 13, 2018 [e0191590].
Eberhardt, R., Anantham, D., Ernst, A., et al. Multimodality bronchoscopic diagnosis of peripheral lung lesions: a randomized controlled trial. Am J Respir Crit Care Med 176 (2007), 36–41.
Kennedy, G.T., Azari, F.S., Bernstein, E., et al. Targeted detection of cancer cells during biopsy allows real-time diagnosis of pulmonary nodules. Eur J Nucl Med Mol Imaging, 49, 2022, 4194.
Deschuyteneer, E.P., De Keukeleire, T., Diagnostic value and safety of thoracoscopic pleural biopsies in pleural exudative effusions of unknown origin, including follow-up. BMJ Open Respir Res, 9, 2022 [e001161].
Kindler, H.L., Ismaila, N., Armato, S.G., et al. Treatment of malignant pleural mesothelioma: American society of clinical oncology clinical practice guideline. J Clin Oncol 36 (2018), 1343–1373.
Galbis, J.M., Mata, M., Guijarro, R., et al. Clinical-therapeutic management of thoracoscopy in pleural effusion: a groundbreaking technique in the twenty-first century. Clin Transl Oncol 13 (2011), 57–60.
Loddenkemper, R., Thoracoscopy–state of the art. Eur Respir J 11 (1998), 213–221.
Prakash Ubs, Reiman, Hm., Comparison of needle biopsy with cytologic analysis for the evaluation of pleural effusion: analysis of 414 Cases. Mayo Clin Proc 60 (1985), 158–164.
Zirlik, S., Hildner, K., Rieker, R.J., et al. Confocal laser endomicroscopy for diagnosing malignant pleural effusions. Med Sci Monit 24 (2018), 5437–5447.
Bonhomme, O., Duysinx, B., Heinen, V., et al. First report of probe based confocal laser endomicroscopy during medical thoracoscopy. Respir Med 147 (2019), 72–75.
Wijmans, L., Baas, P., Sieburgh, T.E., et al. Confocal laser endomicroscopy as a guidance tool for pleural biopsies in malignant pleural mesothelioma. Chest 156 (2019), 754–763.
Bonhomme, O., Heinen, V., Detrembleur, N., et al. Probe-based confocal laser endomicroscopy for pleural malignancies diagnosis. Respirology 26 (2021), 188–195.
Ellayeh, M., Bedawi, E., Banka, R., et al. Objective thoracoscopic criteria in differentiation between benign and malignant pleural effusions. Respiration 101 (2022), 46–56 [cited 2023].
Hallifax, R.J., Corcoran, J.P., Psallidas, I., et al. Medical thoracoscopy: survey of current practice-How successful are medical thoracoscopists at predicting malignancy?. Respirology 21 (2016), 958–960.
Porfyridis, I., Georgiadis, G., Michael, M., et al. Rapid on-site evaluation with the hemacolor rapid staining method of medical thoracoscopy biopsy specimens for the management of pleural disease. Respirology 21 (2016), 1106–1112.
Sawada, T., Takizawa, H., Aoyama, M., et al. Diagnosis of visceral pleural invasion using confocal laser endomicroscopy during lung cancer surgery. J Thorac Dis 13 (2021), 4742–4752.
Danilevskaya, O., Averyanov, A., Lesnyak, V., et al. Confocal laser endomicroscopy for diagnosis and monitoring of pulmonary alveolar proteinosis. J Bronchology Interv Pulmonol 22 (2015), 33–40.
Salaün, M., Roussel, F., Bourg-Heckly, G., et al. In vivo probe-based confocal laser endomicroscopy in amiodarone-related pneumonia. Eur Respir J 42 (2013), 1646–1658.
Danilevskaya, O., Averyanov, A., Klimko, N., et al. The case of diagnostics of invasive pulmonary aspergillosis by in vivo probe-based confocal laser endomicroscopy of central and distal airways. Med Mycol Case Rep 5 (2014), 35–39.
Meng, P., Tan, G.L., Low, S.Y., et al. Fibred confocal fluorescence microscopy in the diagnosis of interstitial lung diseases. J Thorac Dis 8 (2016), 3505–3514.
Salaün, M., Guisier, F., Dominique, S., et al. In vivo probe-based confocal laser endomicroscopy in chronic interstitial lung diseases: Specific descriptors and correlation with chest CT. Respirology 24 (2019), 783–791.
Silbernagel, E., Stacher-Priehse, E., Dinkel, J., et al. Bronchoscopic probe-based confocal laser endomicroscopy to diagnose diffuse parenchymal lung diseases. Sarcoidosis Vasc Diffuse Lung Dis, 39, 2022 [2022016].
Wijmans, L., Kalverda, K., de Bruin, D., et al. Bronchoscopic journey of in vivo real-time microscopic imaging in ILD: a case series. Respiration 101 (2022), 1006–1014.
Wijmans, L., Bonta, P.I., Rocha-Pinto, R., et al. Confocal laser endomicroscopy as a guidance tool for transbronchial lung cryobiopsies in interstitial lung disorder. Respiration 97 (2019), 259–263.
Yserbyt, J., Dooms, C., Decramer, M., et al. Acute lung allograft rejection: diagnostic role of probe-based confocal laser endomicroscopy of the respiratory tract. J Heart Lung Transplant 33 (2014), 492–498.
Keller, C.A., Khoor, A., Arenberg, D.A., et al. Diagnosis of acute cellular rejection using probe-based confocal laser endomicroscopy in lung transplant recipients: a prospective, multicenter trial. Transplantation 103 (2019), 428–434.
Goorsenberg, A., Kalverda, K.A., Annema, J., et al. Advances in optical coherence tomography and confocal laser endomicroscopy in pulmonary diseases. Respiration 99 (2020), 190–205.
Napoleon, B., Palazzo, M., Lemaistre, A., et al. Needle-based confocal laser endomicroscopy of pancreatic cystic lesions: a prospective multicenter validation study in patients with definite diagnosis Authors. Endoscopy 51 (2019), 825–835.
Fumex, F., Napoleon, B., Lucidarme, D., et al. A novel approach to the diagnosis of pancreatic serous cystadenoma: needle-based confocal laser endomicroscopy. Endoscopy 47 (2015), 26–32.
Moussata, D., Goetz, M., Gloeckner, A., et al. Confocal laser endomicroscopy is a new imaging modality for recognition of intramucosal bacteria in inflammatory bowel disease in vivo. Gut 60 (2011), 26–33.
Gruber, S., Spielauer, I., Böhme, S., et al. Real-time in-vivo imaging of pulmonary capillary perfusion using probe-based confocal laser scanning endomicroscopy in pigs. Eur J Anaesthesiol 32 (2015), 392–399.
Uno, K., Koike, T., Hatta, W., et al. Development of advanced imaging and molecular imaging for Barrett's neoplasia. Diagnostics (Basel), 12, 2022, 2437.
Hsiung, P.L., Hsiung, P.L., Hardy, J., et al. Detection of colonic dysplasia in vivo using a targeted heptapeptide and confocal microendoscopy. Nat Med 14 (2008), 454–458.
