Advances in bronchoscopic optical coherence tomography and confocal laser endomicroscopy in pulmonary diseases

Abstract

Purpose of reviewImaging techniques play a crucial role in the diagnostic work-up of pulmonary diseases but generally lack detailed information on a microscopic level. Optical coherence tomography (OCT) and confocal laser endomicroscopy (CLE) are imaging techniques which provide microscopic images in vivo during bronchoscopy. The purpose of this review is to describe recent advancements in the use of bronchoscopic OCT- and CLE-imaging in pulmonary medicine.Recent findingsIn recent years, OCT- and CLE-imaging have been evaluated in a wide variety of pulmonary diseases and demonstrated to be complementary to bronchoscopy for real-time, near-histological imaging. Several pulmonary compartments were visualized and characteristic patterns for disease were identified. In thoracic malignancy, OCT- and CLE-imaging can provide characterization of malignant tissue with the ability to identify the optimal sampling area. In interstitial lung disease (ILD), fibrotic patterns were detected by both (PS-) OCT and CLE, complementary to current HRCT-imaging. For obstructive lung diseases, (PS-) OCT enables to detect airway wall structures and remodelling, including changes in the airway smooth muscle and extracellular matrix.SummaryBronchoscopic OCT- and CLE-imaging allow high resolution imaging of airways, lung parenchyma, pleura, lung tumours and mediastinal lymph nodes. Although investigational at the moment, promising clinical applications are on the horizon.

Needle‐based confocal laser endomicroscopy for real‐time granuloma detection

“…Needle‐based confocal laser endomicroscopy (nCLE) is a laser‐based imaging technique that utilizes fluorescence for real‐time microscopic imaging at the biopsy needle tip 7,8 . Recent studies demonstrated that nCLE‐imaging in mediastinal lymph nodes and lung nodules can detect malignancy based on three nCLE criteria (enlarged pleomorphic cells, dark clumps and directional streaming) 9–12 .…”

“…Needle-based confocal laser endomicroscopy (nCLE) is a laser-based imaging technique that utilizes fluorescence for real-time microscopic imaging at the biopsy needle tip. 7,8 Recent studies demonstrated that nCLE-imaging in mediastinal lymph nodes and lung nodules can detect malignancy based on three nCLE criteria (enlarged pleomorphic cells, dark clumps and directional streaming). [9][10][11][12] Currently, (robotic-)bronchoscopic nCLE-imaging of peripheral lung nodules is used in research and selected clinical settings for real-time fine-tuning of the needle positioning.…”