Department of Respiratory Medicine, Amsterdam University Medical Centers, Amsterdam.
Department of Thoracic Oncology, Netherlands Cancer Institute, Amsterdam.
Chest. 2019 Oct;156(4):754-763. doi: 10.1016/j.chest.2019.04.090. Epub 2019 May 7.
Pleural biopsies in patients with suspected malignant pleural mesothelioma (MPM) are often inconclusive resulting in repeat diagnostic procedures. Confocal laser endomicroscopy (CLE) enables real-time imaging on a cellular level. We investigated pleural CLE imaging as a biopsy guidance technique to distinguish malignant from benign pleural disease.
Prospective, multicenter study in patients with (suspected) MPM based on PET-CT imaging who were scheduled for pleural biopsies. Patients received 2.5 mL fluorescein intravenously preceding the procedure. In vivo through-the-needle CLE imaging of the pleura and ex vivo CLE imaging of the biopsies were correlated with histology. CLE characteristics for various pleural entities were identified, and their interpretability was tested by CLE video scoring by multiple blinded raters.
CLE imaging was successfully obtained in 19 of 20 diagnostic pleural biopsy procedures (thoracoscopy: n = 4, surgical excision: n = 3, CT scan: n = 3, ultrasound: n = 9, esophageal ultrasound guided: n = 1) in 15 patients. CLE videos (n = 89) and corresponding pleural biopsies (n = 105) were obtained. No study-related adverse events occurred. Tumor deposits of MPM were distinguished from areas with pleural fibrosis based on CLE imaging and recognized by raters (n = 3) (interobserver agreement, 0.56; 95% CI, 0.49-0.64).
CLE imaging was feasible and safe regardless of the biopsy method. Real-time visualization of pleural abnormalities in epithelial and sarcomatoid MPM could be distinguished from pleural fibrosis. Therefore, CLE has potential as a guidance biopsy tool to reduce the current substantial rate of repeat biopsy procedures by identification of areas with malignant cells in vivo (smart needle).
ClinicalTrials.gov; No.: NCT02689050; URL: www.clinicaltrials.gov.
怀疑患有恶性胸膜间皮瘤（MPM）的患者进行胸膜活检通常结果不确定，导致需要重复诊断程序。共聚焦激光内窥镜检查（CLE）能够实现细胞水平的实时成像。我们研究了胸膜 CLE 成像作为一种活检引导技术，以区分恶性和良性胸膜疾病。
前瞻性、多中心研究，纳入了基于 PET-CT 成像怀疑患有 MPM 的患者，这些患者计划进行胸膜活检。在进行该程序之前，患者静脉注射 2.5ml 荧光素。对胸膜进行经皮 CLE 成像，对活检标本进行离体 CLE 成像，并将这两种方法与组织学进行比较。确定了各种胸膜实体的 CLE 特征，并通过多位盲法评分者对 CLE 视频进行评分，以测试其可解释性。
15 名患者中有 19 名成功进行了 20 例诊断性胸膜活检（胸腔镜：n=4，外科切除：n=3，CT 扫描：n=3，超声：n=9，超声引导食管镜：n=1），共获得 19 例 CLE 视频（n=89）和相应的胸膜活检标本（n=105）。没有发生与研究相关的不良事件。根据 CLE 成像，MPM 的肿瘤沉积物与胸膜纤维化区分开来，并被评分者识别（n=3）（观察者间一致性，0.56；95%CI，0.49-0.64）。
无论采用何种活检方法，CLE 成像都是可行且安全的。上皮型和肉瘤样 MPM 的胸膜异常的实时可视化可以与胸膜纤维化区分开来。因此，CLE 具有作为引导活检工具的潜力，通过在体内识别有恶性细胞的区域（智能针），可以减少目前大量的重复活检程序。
ClinicalTrials.gov；编号：NCT02689050；网址：www.clinicaltrials.gov。
