Seitlinger Joseph, Stasiak Florent, Streit Arthur, Wollbrett Christophe, Siat Joelle, Schnedecker Lucie, Gauchotte Guillaume, Renaud Stéphane
Thoracic Surgery Department, University Hospital Nancy, Nancy, France.
Research Unit Institut National de la Santé et de la Recherche Médicale U1256, Nancy, France.
J Thorac Dis. 2024 Aug 31;16(8):4986-4993. doi: 10.21037/jtd-24-546. Epub 2024 Aug 12.
The widespread deployment of screening programs has increased the number of suspected pulmonary nodules diagnosed. The main objective of this retrospective study was to evaluate the concordance between needle-based confocal laser endomicroscopy (nCLE) image patterns and pathology reports.
In this retrospective study, we reviewed all cases of endobronchial navigational bronchoscopy (ENB) performed using the nCLE system as a guide for injecting a dye marker or for biopsy of a lung nodule. All surgeries were performed at the Thoracic Surgery Department, University Hospital Nancy, France, between June and October 2023. All navigation procedures were performed under general anesthesia by a senior resident supervised by a senior surgeon, and endobronchial positioning assistance was provided by using the nCLE probe.
A total of 30 patients were included in this study. The median size of the suspicious lesions was 16 mm [interquartile range (IQR), 13 mm]. The average time the nCLE system was in contact with the lesion was 5 minutes (IQR, 5 minutes). In 22/30 patients, dark, enlarged pleomorphic cells were visualized, and for one patient, a mix of dark clusters and dark enlarged pleomorphic cells was visualized, leading to a diagnosis of cancer in 22/23 patients (95.6%). For five patients, dark clusters were visualized, resulting in a diagnosis of cancer in 100% of patients. Pathology was performed for 6/30 patients/21 (20%) by endobronchial biopsy and for 24 patients by surgical resection of the suspicious lesion (80%).
By retrospectively analyzing the nCLE lung cancer criteria published by Wijmans in 2019, we observed 95.6% and 100% positive diagnoses according to the images visualized during the assistance of positioning. We believe that this type of technology could be used in the future for endobronchial analysis of suspected lesions and eventually for replacing frozen section analysis. However, the diagnostic value of this system needs to be confirmed, particularly for benign lesions.
筛查项目的广泛开展增加了诊断出的疑似肺结节数量。这项回顾性研究的主要目的是评估基于针的共聚焦激光内镜检查（nCLE）图像模式与病理报告之间的一致性。
在这项回顾性研究中，我们回顾了所有使用nCLE系统作为注射染料标记物或肺结节活检引导的支气管内导航支气管镜检查（ENB）病例。所有手术均于2023年6月至10月在法国南锡大学医院胸外科进行。所有导航程序均在全身麻醉下由一名高级住院医师在一名高级外科医生的监督下进行，并使用nCLE探头提供支气管内定位辅助。
本研究共纳入30例患者。可疑病变的中位大小为16毫米[四分位间距（IQR），13毫米]。nCLE系统与病变接触的平均时间为5分钟（IQR，5分钟）。在22/30例患者中，可见深色、增大的多形性细胞，1例患者可见深色簇与深色增大的多形性细胞混合，导致22/23例患者（95.6%）诊断为癌症。5例患者可见深色簇，100%的患者诊断为癌症。30例患者中的6例（20%）通过支气管活检进行病理检查，24例患者通过手术切除可疑病变进行病理检查（80%）。
通过回顾性分析Wijmans于2019年发布的nCLE肺癌标准，我们根据定位辅助过程中可视化的图像观察到阳性诊断率分别为95.6%和100%。我们认为，这种技术未来可用于支气管内对可疑病变的分析，并最终用于替代冰冻切片分析。然而，该系统的诊断价值需要得到证实，尤其是对于良性病变。
