Structure–function relationship in COPD revisited: an in vivo microscopy view

Cosío, Borja G.; Shafiek, Hanaa; Fiorentino, Federico; Gómez, Cristina; López, Meritxell; Ríos, Ángel; Kersul, Ana; Togores, Bernardo; Palmer, Joan; Sauleda, Jaume; Agustí, Àlvar

doi:10.1136/thoraxjnl-2013-204479

Cited by 10 publications

(14 citation statements)

References 29 publications

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“…The ultimate outcome measure is to visualise the pathological process directly in vivo. Cosio et al ,44 in our SILVER MEDAL paper in this category, show that this might be possible in patients with COPD using a standard broncoscopy and fibred confocal florescence microscopy. Patient reported outcome measures are also much to the fore.…”

Section: Adult Clinical Year In Reviewmentioning

confidence: 80%

Year in review 2014. Paediatric and adult clinical studies

Bush

Pavord

2015

Thorax

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Section: Adult Clinical Year In Reviewmentioning

confidence: 80%

Year in review 2014. Paediatric and adult clinical studies

Bush

Pavord

2015

Thorax

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“…Previous studies used pCLE to investigate interstitial lung disease, alveolar proteinosis, drug-induced (amiodarone) pneumonitis, lung cancer [15,16,17,18] and, very recently, chronic obstructive pulmonary disease [9]. To the best of our knowledge, this is the first study to investigate the potential clinical usefulness of pCLE in the diagnosis of PJP in HIV+ patients.…”

Section: Discussionmentioning

confidence: 95%

“…pCLE (Cellvizio®-Lung, 488 nm excitation, Mauna Kea Technologies, Paris, France) was used, as previously described by Thiberville et al [3] and Cosio et al [9]. In brief, the bronchoscope is wedged into the smallest reachable bronchi and a Confocal Miniprobe™ (AlveoFlex, 1.4 mm in diameter, Paris, France) introduced through its working channel and advanced into the distal bronchiole until the alveolar space is seen.…”

Section: Methodsmentioning

confidence: 99%

“…In case of discordance, a final consensus decision was reached after a new analysis of the imaging sequence by the two observers together. Build-in software (MedViewer®1.1.1; Mauna Kea Technologies, Paris, France) was used for the measurement of the extra-alveolar vessel diameter, alveolar diameter, alveolar elastic fiber thickness and alveolar fluorescence intensity as previously described [3,8,9]. …”

Section: Methodsmentioning

confidence: 99%

“…A laser beam at the end of the miniprobe elicits fluorescence of the tissue surface which is recorded in the system and analyzed off-line [8]. As we have shown recently [9], pCLE can image and quantify the elastin network of the airways including alveolar ducts, alveolar entrance rings and extra-alveolar microvessels (alveoloscopy), as well as alveolar macrophages in vivo [3]. …”

Section: Introductionmentioning

confidence: 99%

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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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