Confocal Laser Endomicroscopy for Diagnosis and Monitoring of Pulmonary Alveolar Proteinosis

Danilevskaya, Olesya; Averyanov, Alexander; Lesnyak, Victor; Chernyaev, A. L.; Sorokina, Anastasia

doi:10.1097/lbr.0000000000000126

Cited by 28 publications

(22 citation statements)

References 19 publications

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“…Similar results were reported in a large series of transplanted patients in whom pCLE provided specific imaging in acute allograft rejection . In PAP, pCLE examination showed fluorescent floating proteinaceous material filling the alveolar areas . In amiodarone‐related ILD, pCLE showed constantly large alveolar fluorescent cells …”

Section: Discussionsupporting

confidence: 85%

In vivo probe‐based confocal laser endomicroscopy in chronic interstitial lung diseases: Specific descriptors and correlation with chest CT

et al. 2019

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Background and objective: Probe-based confocal laser endomicroscopy (pCLE) enables in vivo microimaging of the distal lung, during bronchoscopy. This study aims at identifying pCLE descriptors of chronic interstitial lung diseases (ILD), their correlations with chest HRCT and assessing inter-observer agreement. Methods: pCLE was performed in 21 healthy volunteers (HV) and 59 non-smoking ILD patients, including 19 patients with idiopathic pulmonary fibrosis (IPF) or asbestosis, 15 with connective tissue disease-associated ILD (CTD-ILD), 17 with sarcoidosis and 8 with hypersensitivity pneumonitis (HP). pCLE descriptors were identified in ILD on the basis of comparison with HV. Results: Nine pCLE descriptors were more frequent in ILD compared to HV, with good inter-observer agreement, including fluorescent bronchiolar cells (sarcoidosis, CTD-ILD and HP), fluorescent alveolar cells (CTD-ILD and HP), small alveolar entrance rings (IPF or asbestosis and CTD-ILD), enlarged axial elastic fibres (IPF or asbestosis), septal fibres (IPF or asbestosis, CTD-ILD and HP), disorganized acinar network and rigid acinar network (IPF or asbestosis and CTD-ILD), dense elastic network (IPF or asbestosis) and alveolar fluorescent nodular structures (in sarcoidosis) (P < 0.01, Fisher's exact test, all comparisons). The distribution of nodules on computed tomography (CT) appeared to correlate with pCLE alveolar nodular structures, rigid acinar network and septal fibres, while reticulations were associated with septal fibres and disorganized or dense acinar network; ground-glass opacities on CT with small alveolar entrances, rigid elastic network and septal fibres; and honeycombing with septal fibres. Conclusion:In the four groups of ILD studied, 9 pCLE descriptors are described, which appear specific and reproducible, and correlate with chest HRCT patterns. Clinical trial registration: NCT00377338 at ClinicalTrials.govProbe-based confocal laser endomicroscopy (pCLE) enables to image the acinar and alveolar areas at the microscopic level in vivo during flexible bronchoscopy. This study provides reproducible pCLE descriptors of idiopathic pulmonary fibrosis (IPF), asbestosis, connective-tissue disease-related interstitial lung diseases (ILD), sarcoidosis and hypersensitivity pneumonitis, which can be used to conduct prospective and follow-up studies.

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Section: Discussionsupporting

confidence: 85%

In vivo probe‐based confocal laser endomicroscopy in chronic interstitial lung diseases: Specific descriptors and correlation with chest CT

et al. 2019

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“…Endogenous fluorescence allows elastin and tobacco-tar laden macrophages (in smokers) to be identified without the use of intravenous contrast (10). FCFM has already been used to identify malignancy, acute rejection in lung transplantation, amiodarone lung and pulmonary alveolar proteinosis in pilot data (11)(12)(13).…”

Section: Original Articlementioning

confidence: 99%

Fibred confocal fluorescence microscopy in the diagnosis of interstitial lung diseases

et al. 2016

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Background: Accurate diagnosis is critical to both therapeutic decisions and prognostication in interstitial lung diseases (ILD). However, surgical lung biopsies carry high complication rates. Fibred confocal fluorescence microscopy (FCFM) offers an alternative as it can visualize lung tissue in vivo at the cellular level with minimal adverse events. We wanted to investigate the diagnostic utility, and safety of using FCFM for patients with ILD.Methods: In patients with suspected ILD, FCFM images were obtained from multiple bronchopulmonary segments using a miniprobe inserted through the working channel of a flexible bronchoscope. The procedure was performed under moderate sedation in an outpatient setting. Morphometric measurements and fibre pattern analyses were co-related with computed tomography (CT) findings and patients' final diagnoses based on multi-disciplinary consensus.Results: One hundred and eighty four segments were imaged in 27 patients (18 males) with a median age of 67 years (range, 24-79 years). They were grouped into chronic fibrosing interstitial pneumonia (16 patients) and other ILDs. Six distinct FCFM patterns were observed: normal, increased fibres, densely packed fibres, hypercellular, thickened fibres and others/non-specific. The pattern resembling densely packed fibres was seen in at least one segment in 68.8% patients with chronic fibrosing interstitial pneumonia, but only 36.4% in other ILD (P=0.097). An association between inflammatory patterns on CT and a hypercellular pattern on FCFM was also found (P<0.001).Conclusions: Our study shows the potential of FCFM in classifying ILD, but its role in further diagnosis remains limited.

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“…Bronchoscopy is a minimally invasive procedure that allows pCLE but can also obtain respiratory secretions and bronchoalveolar lavage allowing their analyses identifying other potential microorganisms. We do not defend the replacement of lesser invasive techniques but we stress a new inclusion of pCLE indication besides pulmonary aspergillosis, alveolar proteinosis, drug pneumonitis and lung cancer [15,16,17,18,38,39]. …”

Section: Discussionmentioning

confidence: 99%

Usefulness of Bronchoscopic Probe-Based Confocal Laser Endomicroscopy in the Diagnosis of <b><i>Pneumocystis jirovecii</i></b> Pneumonia

Shafiek

Fiorentino²,

Cosío³

et al. 2016

Respiration

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Background: Probe-based confocal laser endomicroscopy (pCLE) is a novel technique that provides in vivo microscopic imaging of the distal lung. We hypothesized that the intra-alveolar exudates characterizing Pneumocystis jirovecii pneumonia (PJP) can be identified by pCLE in vivo and help in its diagnosis. Objectives: We aimed toassess the usefulness of pCLE for the in vivo diagnosis of PJP. Methods: Thirty-two human immunodeficiency virus (HIV)-positive patients with new pulmonary infiltrates and fever were studied using pCLE. Real-time alveolar images were recorded during the bronchoscopy for off-line analysis by two independent observers. Bronchoalveolar lavage samples were also obtained and processed for microbiology and cytological evaluation, including Grocott stain for P. jirovecii. The sensitivity, specificity, positive predictive value (PPV) and negative predictive value (NPV) of pCLE for the diagnosis of PJP in these patients were calculated. Results: Fourteen patients (44%) were confirmed to have PJP by cultures/staining. pCLE was well tolerated in all patients. It identified intra-alveolar exudates in 13 of them (41%), where 11 of them (85%) had positive Grocott stain for P. jirovecci, with 93% concordance between observers. Sensitivity, specificity, PPV and NPV of pCLE for the diagnosis of PJP were 79, 89, 85 and 84%, respectively. In smokers, these figures improved to be 92, 88, 85 and 94%. Conclusions: pCLE is a quick and safe procedure for on-site diagnosis of PJP in HIV+ patients with excellent specificity and sensitivity mainly in smokers.

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Confocal Laser Endomicroscopy for Diagnosis and Monitoring of Pulmonary Alveolar Proteinosis

Cited by 28 publications

References 19 publications

In vivo probe‐based confocal laser endomicroscopy in chronic interstitial lung diseases: Specific descriptors and correlation with chest CT

In vivo probe‐based confocal laser endomicroscopy in chronic interstitial lung diseases: Specific descriptors and correlation with chest CT

Fibred confocal fluorescence microscopy in the diagnosis of interstitial lung diseases

Usefulness of Bronchoscopic Probe-Based Confocal Laser Endomicroscopy in the Diagnosis of <b><i>Pneumocystis jirovecii</i></b> Pneumonia

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