PT  - JOURNAL ARTICLE
AU  - L. Wijmans
AU  - J. Yared
AU  - D.M. de Bruin
AU  - S.L. Meijer
AU  - P. Baas
AU  - P.I. Bonta
AU  - J.T. Annema
TI  - Needle-based confocal laser endomicroscopy (nCLE) for real-time diagnosing and staging of lung cancer
AID  - 10.1183/13993003.01520-2018
DP  - 2019 Jan 01
TA  - European Respiratory Journal
PG  - 1801520
4099  - http://erj.ersjournals.com/content/early/2019/03/15/13993003.01520-2018.short
4100  - http://erj.ersjournals.com/content/early/2019/03/15/13993003.01520-2018.full
AB  - Objectives Diagnosing lung cancer in the absence of endobronchial abnormalities is challenging. Needle-based confocal laser endomicroscopy (nCLE) enables real-time microscopic imaging of cells. We assessed the feasibility and safety of using nCLE for real time identification of lung cancerMaterials and methods In patients with suspected or proven lung cancer scheduled for endoscopic ultrasound (EUS), lung tumours and mediastinal lymph nodes were imaged with nCLE before fine needle aspiration (FNA) was performed. nCLE lung cancer characteristics were identified by comparison with pathology. Multiple blinded raters validated CLE videos of lung tumours and mediastinal nodes twice.Results EUS-nCLE-FNA was performed in 22 patients with suspected or proven lung cancer in whom 27 lesions (6 tumours, 21 mediastinal nodes) were evaluated without complications. Three nCLE-lung cancer criteria (enlarged pleomorphic cells, dark clumps, directional streaming) were identified. Accuracy of nCLE imaging for detecting malignancy in tumours and metastatic lymph nodes was 90% and 89% respectively. Both interobserver (mean IOA (k=0.68 (95% CI: 0.66–0.70)) and intra-observer agreement (mean IOR (k=0.70±0.15)), were substantial.Conclusion Real-time lung cancer detection by endosonography-guided nCLE was feasible and safe. Lung cancer characteristics were accurately recognised.FootnotesThis manuscript has recently been accepted for publication in the European Respiratory Journal. It is published here in its accepted form prior to copyediting and typesetting by our production team. After these production processes are complete and the authors have approved the resulting proofs, the article will move to the latest issue of the ERJ online. Please open or download the PDF to view this article.Conflict of interest: Dr. Wijmans has nothing to disclose.Conflict of interest: Dr. Yared has nothing to disclose.Conflict of interest: Dr. de Bruin has nothing to disclose.Conflict of interest: Dr. Meijer has nothing to disclose.Conflict of interest: Dr. Baas has nothing to disclose.Conflict of interest: Dr. Bonta has nothing to disclose.Conflict of interest: Dr. Annema reports non-financial support from Mauna Kea Technologies, during the conduct of the study.