Department of Pulmonology, Amsterdam University Medical Centers, University of Amsterdam, Amsterdam, The Netherlands,
Department of Pulmonology, Amsterdam University Medical Centers, University of Amsterdam, Amsterdam, The Netherlands.
Respiration. 2020;99(3):190-205. doi: 10.1159/000503261. Epub 2019 Oct 8.
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.
诊断和监测肺部疾病高度依赖于成像、生理功能测试和组织采样。光学相干断层扫描（OCT）和共焦激光内窥检查（CLE）是具有近微观分辨率的新型成像技术，可与常规支气管镜轻松、安全地结合。使用这些技术可以实时可视化与疾病相关的肺部解剖区室。在阻塞性肺部疾病中，可以识别和量化气道壁层和相关结构重塑。在恶性肺部疾病中，可以区分中央气道、肺实质、淋巴结和胸膜的正常和恶性区域。越来越多的间质性肺疾病（ILDs）已使用 OCT 或 CLE 可视化。可以对几种与 ILD 相关的结构变化进行成像：纤维化、细胞浸润、细支气管扩张、囊肿和微观蜂窝状。尽管尚未在临床实践中实施，但 OCT 和 CLE 具有改善检测和监测肺部疾病的潜力，并有助于揭示疾病的病理生理学和新型治疗方法的作用机制。事实上，OCT 评估气道壁层可能有助于评估针对气道重塑的治疗方法。通过可视化单个恶性细胞，CLE 具有作为实时肺癌检测工具的潜力。未来，这两种技术都可以与激光增强荧光标记示踪剂检测相结合。本综述通过总结现有证据并阐述未来前景，讨论了 OCT 和 CLE 在肺部医学中的价值。
