Assessing the feasibility of confocal laser endomicroscopy in solitary pulmonary nodules for different part of the lungs, using either 0.6 or 1.4 mm probes

被引:30
作者
Hassan, Tidi [1 ,2 ,3 ]
Thiberville, Luc [1 ,2 ,4 ]
Hermant, Christophe [5 ]
Lachkar, Samy [1 ,2 ]
Piton, Nicolas [6 ]
Guisier, Florian [1 ,2 ,4 ]
Salaun, Mathieu [1 ,2 ,4 ]
机构
[1] Rouen Univ Hosp, Thorac Oncol & Resp Intens Care, Dept Resp Care, Rouen, France
[2] Rouen Univ Hosp, CIC, CRB, U1404, Rouen, France
[3] Univ Kebangsaan Malaysia, Fac Med, Dept Med, Cheras, Malaysia
[4] Normandie Univ, UNIROUEN, LITIS, Quant IF, Rouen, France
[5] Univ Toulouse III Paul Sabatier, CHU Toulouse, Hop Larrey, Serv Pneumol Allergol, Toulouse, France
[6] Rouen Univ Hosp, Dept Pathol & Cytol, Rouen, France
关键词
FLUORESCENCE MICROSCOPY; CANCER; PROBABILITY; BRONCHOSCOPY; DIAGNOSIS; CT;
D O I
10.1371/journal.pone.0189846
中图分类号
O [数理科学和化学]; P [天文学、地球科学]; Q [生物科学]; N [自然科学总论];
学科分类号
07 ; 0710 ; 09 ;
摘要
Background Malignant solitary pulmonary nodules (SPN) have become more prevalent, with upper lobes predilection. Probe-based confocal laser endomicroscopy (pCLE) provides in-vivo imaging of SPN. However, the stiffness of the 1mm confocal probe (AlveoFlex) causes difficult accessibility to the upper lobes. A thinner 600 mu m probe designed for bile duct exploration (CholangioFlex) has the potential to reach the upper lobes. Objectives To examine the accessibility of malignant SPNs in all segments of the lungs using either the 0.6mm or 1.4 mm probe and to assess the quality and inter observer interpretation of SPN confocal imaging obtained from either miniprobes. Methods Radial(r)-EBUS was used to locate and sample the SPN. In-vivo pCLE analysis of the SPN was performed using either CholangioFlex (apical and posterior segments of the upper lobes) or AlveoFlex (other segments) introduced into the guide sheath before sampling. pCLE features were compared between the two probes. Results Fourty-eight patients with malignant SPN were included (NCT01931579). The diagnostic accuracy for lung cancer using r-EBUS coupled with pCLE imaging was 79.2%. All the SPNs were successfully explored with either one of the probes (19 and 29 subjects for CholangioFlex and AlveoFlex, respectively). A specific solid pattern in the SPN was found in 30 pCLE explorations. Comparison between the two probes found no differences in the axial fibers thickness, cell size and specific solid pattern in the nodules. Extra-alveolar microvessel size appeared larger using CholangioFlex suggesting less compression effect. The kappa test for interobserver agreement for the identification of solid pattern was 0.74 (p = 0.001). Conclusion This study demonstrates that pCLE imaging of SPNs is achievable in all segments of both lungs using either the 0.6mm or 1.4mm miniprobe.
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页数:16
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