Respiratory Medicine, Amsterdam University Medical Centers, Amsterdam, Noord-Holland, The Netherlands.
Department of Biomedical Engineering and Physics, Amsterdam University Medical Centers, Amsterdam, Noord-Holland, The Netherlands.
Thorax. 2022 Apr;77(4):370-377. doi: 10.1136/thoraxjnl-2021-216885. Epub 2021 Jun 25.
Diagnosing peripheral lung cancer with the bronchoscope is challenging with near miss of the target lesion as major obstacle. Needle-based confocal laser endomicroscopy (nCLE) enables real-time microscopic tumour visualisation at the needle tip (smart needle).
To investigate feasibility and safety of bronchoscopic nCLE imaging of suspected peripheral lung cancer and to assess whether nCLE imaging allows real-time discrimination between malignancy and airway/lung parenchyma.
Patients with suspected peripheral lung cancer based on (positron emission tomography-)CT scan underwent radial endobronchial ultrasound (rEBUS) and fluoroscopy-guided flexible bronchoscopy. After rEBUS lesion detection, an 18G needle loaded with the CLE probe was inserted in the selected airway under fluoroscopic guidance. The nCLE videos were obtained at the needle tip, followed by aspirates and biopsies. The nCLE videos were reviewed and compared with the cytopathology of the corresponding puncture and final diagnosis. Five blinded raters validated nCLE videos of lung tumours and airway/lung parenchyma twice.
The nCLE imaging was performed in 26 patients. No adverse events occurred. In 24 patients (92%) good to high quality videos were obtained (final diagnosis; lung cancer n=23 and organising pneumonia n=1). The nCLE imaging detected malignancy in 22 out of 23 patients with lung cancer. Blinded raters differentiated nCLE videos of malignancy from airway/lung parenchyma (280 ratings) with a 95% accuracy. The inter-observer agreement was substantial (κ=0.78, 95% CI 0.70 to 0.86) and intra-observer reliability excellent (mean±SD κ=0.81±0.05).
Bronchoscopic nCLE imaging of peripheral lung lesions is feasible, safe and allows real-time lung cancer detection. Blinded raters accurately distinguished nCLE videos of lung cancer from airway/lung parenchyma, showing the potential of nCLE imaging as real-time guidance tool.
使用支气管镜诊断周围型肺癌具有挑战性,主要障碍是目标病变的近切。基于针的共聚焦激光内窥镜(nCLE)可在针尖实时显示微观肿瘤(智能针)。
研究怀疑为周围型肺癌的支气管镜 nCLE 成像的可行性和安全性,并评估 nCLE 成像是否允许实时区分良恶性和气道/肺实质。
根据(正电子发射断层扫描)-CT 扫描怀疑为周围型肺癌的患者接受径向支气管内超声(rEBUS)和透视引导下的软式支气管镜检查。rEBUS 检测到病变后,在透视引导下将装载 CLE 探头的 18G 针插入选定的气道中。在针尖处获得 nCLE 视频,然后进行抽吸和活检。审查 nCLE 视频,并将其与相应穿刺的细胞学和最终诊断进行比较。五位盲法评估员对肺肿瘤和气道/肺实质的 nCLE 视频进行了两次验证。
26 例患者进行了 nCLE 成像。未发生不良事件。24 例患者(92%)获得了良好到高质量的视频(最终诊断;肺癌 n=23 例,机化性肺炎 n=1 例)。nCLE 成像在 23 例肺癌患者中的 22 例中检测到恶性肿瘤。盲法评估员将 nCLE 视频中的恶性肿瘤与气道/肺实质区分开来(280 次评分),准确率为 95%。观察者间一致性较高(κ=0.78,95%CI 0.70 至 0.86),观察者内可靠性极好(平均±SD κ=0.81±0.05)。
周围性肺病变的支气管镜 nCLE 成像具有可行性、安全性,可实时检测肺癌。盲法评估员准确区分了 nCLE 视频中的肺癌与气道/肺实质,显示了 nCLE 成像作为实时引导工具的潜力。