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

¹ Rouen University Hospital, Rouen, F-76000 France; and Faculté de Médecine-Pharmacie, Rouen, F-76000 France; LITIS EA 4108 (groupe Quant-IF), Rouen, F-76000 France
² Rouen University Hospital, Rouen, F-76000 France
³ Université Pierre et Marie Curie - Paris 6, Paris, F-75005 France; UMR CNRS 7033, BioMoCeTi, Paris, F-75005 France

^* To whom correspondence should be addressed. E-mail: Luc.Thiberville{at}univ-rouen.fr.

	Abstract

To assess fibered confocal fluorescence microscopy (FCFM) as a tool to image 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 anesthesia, 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 harboring 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 thickness of the acinar elastic fibers was 10±2.5 µm. Alveolar mouth diameters (mean 278±53 µm) were normally distributed but appeared smaller in the right upper lobe and right medial basal segment (p<0.001). Lobular microvessels (median diameter 90 µm) were equally distributed throughout the lungs. Alveolar macrophages were not detectable in non-smokers, 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.

FCFM enables to accurately explore the peripheral lung in-vivo in both smokers and non smokers.

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