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Human in vivo fluorescence microimaging of the alveolar ducts and sacs during bronchoscopy

¹ Rouen University Hospital, ² LITIS EA 4108 (groupe Quant-IF), Faculté de Médecine-Pharmacie, University of Rouen, Rouen, and ³ UMR CNRS 7033, Laboratoire de Biophysique Moléculaire, Cellulaire et Tissulaire, Université Pierre et Marie Curie – Paris 6, Paris, France

CORRESPONDENCE: L. Thiberville, Clinique Pneumologique, Hôpital Charles Nicolle, CHU de Rouen, 1 rue de Germont, 76031 Rouen Cedex, France. Fax: 33 232888240. E-mail: Luc.Thiberville{at}univ-rouen.fr

Keywords: Bronchoscopy, diagnostic imaging, elastin, laser scanning confocal microscopy, pulmonary alveoli, tobacco smoking

Received: June 3, 2008
Accepted December 17, 2008

The aim of the present study was to assess fibred confocal fluorescence microscopy (FCFM) as a tool for imaging the alveolar respiratory system in vivo during bronchoscopy.

A 488-nm excitation wavelength FCFM device was used in 41 healthy subjects including 17 active smokers. After topical anaesthesia, the 1.4-mm miniprobe was introduced into the bronchoscope working channel and advanced distally to the alveoli. Morphometric and cellular analyses were performed on selected frames harbouring a minimal compression effect.

In vivo acinar microimaging was obtained from each lung segment except for the apical and posterior segments of both upper lobes. Reproducible patterns, corresponding to the elastic framework of the axial and peripheral interstitial systems, were recorded from 192 separate acini. The mean±SD thickness of the acinar elastic fibres was 10±2.7 µm. Alveolar mouth diameters (mean±SD 278±53 µm) were normally distributed but appeared smaller in the right upper lobe and right medial basal segment. Lobular microvessels (median diameter 90 µm) were equally distributed throughout the lungs. Alveolar macrophages were not detectable in nonsmokers, whereas a specific tobacco-tar-induced fluorescence was observed in smoking subjects, providing fine details of the alveolar walls and macrophages. A strong correlation was found between the number of cigarettes smoked per day and the amount of large and mobile macrophages observed in vivo, as well as with the intensity of the macrophage alveolitis.

Fibred confocal fluorescence microscopy enables accurate exploration of the peripheral lung in vivo in both smokers and nonsmokers.

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