First report of probe based confocal laser endomicroscopy during medical thoracoscopy

Abstract

Probe based confocal laser endomicroscopy (pCLE) is a new optical endoscopic technique, generating fluorescent light emission from the tissue of interest and allowing in vivo live imaging at a cellular level ("optical biopsies").To the best of our knowledge, this article is the first to present pCLE images during medical thoracoscopy. We present here 3 different patients referred for various health problems. A precise description of pleural cavity pCLE images after intravenous fluorescein injection (a fluorophore) together with corresponding macroscopical and histological studies is performed. This led to the diagnosis of normal pleura in one case, carcinomatous pleuritis in another case and a malignant mesothelioma in the third case.We believe that optical biopsies could help clinicians to make an early diagnosis, thereby allowing rapid therapeutic intervention (talc pleurodesis for example). Furthermore, it could help to guide biopsies when affected zones are not obvious to macroscopic examination.In a near future, new fluorophores could be developed to stain some pathophysiological processes, therapeutic targets, or enzymes activities bringing new insights in endoscopic pleural disease work-up.

Probe‐based confocal laser endomicroscopy for pleural malignancies diagnosis

“…Sometimes, striated muscular fibres could be imaged as large (100 μm) and long (hundreds of μm) parallel dark bands (Fig. 1, Appendix S2‐Video 1 in Supplementary Information) 13 …”

“…Normal and malignant pleural pCLE features are precisely described. Furthermore, 11 criteria were selected according to our previous experience 13 and four of them proved to be associated with the final histological diagnosis (tissue architecture, dysplastic vessels, full chia seed sign and cellular shape homogeneity).…”

“…However, only three thoracoscopies, which is the gold standard procedure for malignant mesothelioma management, 10–12 were included in that study. Otherwise, we have recently reported on three cases of pCLE during medical thoracoscopy with the first description of the parietal pleura during pCLE in a healthy patient and two patients with malignant pleural involvement 13 …”

“…Otherwise, we have recently reported on three cases of pCLE during medical thoracoscopy with the first description of the parietal pleura during pCLE in a healthy patient and two patients with malignant pleural involvement. 13 Although these results suggest that pCLE could be valuable for pleural diseases investigation, large studies describing pleural pCLE in healthy subjects or in pathological conditions are still lacking and needed. Consequently, we conducted a prospective study to assess the pleural pCLE features obtained during thoracoscopy.…”

Shining Light on Pleural Biopsy in Mesothelioma

“…This is the first prospective study of this technique in pleural biopsy and, along with a recent case series of three patients, 11 among the first to report its feasibility. Wijmans et al 8 should be congratulated on this achievement.…”