Edith Silbernagel1, Elvira Stacher-Priehse2, Julien Dinkel3,2,2, Herbert Stepp4, Wolfgang Gesierich5, Michael Lindner6, Juergen Behr2,2, Frank Reichenberger2,2. 1. Pneumology Clinic Altenmark / Pongau, Austria. 2. Department of Pathology, Asklepios Lung Center Munich-Gauting, Germany. 3. Department of Radiology, Asklepios Lung Center Munich-Gauting, Germany. 4. Laser Research Laboratory, LIFE-Center, Ludwig-Maximilians-University of Munich, Germany. 5. Department of Pneumology, Asklepios Lung Center Munich-Gauting, Germany. 6. Department of Thoracic Surgery, University Hospital Salzburg, Austria.
Abstract
Background: Diagnosis of diffuse parenchymal lung disease (DPLD) is based on clinical evaluation, radiological imaging and histology. However, additional techniques are warranted to improve diagnosis. Aims and objective: Probe based confocal laser endomicroscopy (pCLE) allows real time in vivo visualisation of the alveolar compartment during bronchoscopy based on autofluorescence of elastic fibres. We used pCLE (Cellvizio®, Mauna Kea Technology. Inc, Paris, France) to characterise alveolar patterns in patients with different types of DPLD. Methods: In this pilot study we included 42 therapy naive patients (13 female, age 72.6 +/- 2.3 years), who underwent bronchoscopy for workup of DPLD. pCLE images were obtained during rigid bronchoscopy in affected lung segments according to HR-CT scan, followed by cryobiopsies in the identical area. Diagnoses were made by a multidisciplinary panel. The description of pCLE patterns was based on the degree of distortion of the hexagonal alveolar pattern, the density of alveolar structures, the presence of consolidations or loaded alveolar macrophages (AM). The assessment was performed by 2 investigators blinded for the final diagnosis. Results: The normal lung showed a typical alveolar loop pattern. In amiodarone lung disease loaded AM were predominant. COP showed characteristic focal consolidations. IPF was characterized by significant distortion and destruction, NSIP showed significant increase in density, and chronic HP presented with consolidations, mild distortion and density. Conclusion: pCLE shows potential as an adjunctive bronchoscopic imaging technique in the differential diagnosis of DPLD. Structured and quantitative analysis of the images is required.
Background: Diagnosis of diffuse parenchymal lung disease (DPLD) is based on clinical evaluation, radiological imaging and histology. However, additional techniques are warranted to improve diagnosis. Aims and objective: Probe based confocal laser endomicroscopy (pCLE) allows real time in vivo visualisation of the alveolar compartment during bronchoscopy based on autofluorescence of elastic fibres. We used pCLE (Cellvizio®, Mauna Kea Technology. Inc, Paris, France) to characterise alveolar patterns in patients with different types of DPLD. Methods: In this pilot study we included 42 therapy naive patients (13 female, age 72.6 +/- 2.3 years), who underwent bronchoscopy for workup of DPLD. pCLE images were obtained during rigid bronchoscopy in affected lung segments according to HR-CT scan, followed by cryobiopsies in the identical area. Diagnoses were made by a multidisciplinary panel. The description of pCLE patterns was based on the degree of distortion of the hexagonal alveolar pattern, the density of alveolar structures, the presence of consolidations or loaded alveolar macrophages (AM). The assessment was performed by 2 investigators blinded for the final diagnosis. Results: The normal lung showed a typical alveolar loop pattern. In amiodarone lung disease loaded AM were predominant. COP showed characteristic focal consolidations. IPF was characterized by significant distortion and destruction, NSIP showed significant increase in density, and chronic HP presented with consolidations, mild distortion and density. Conclusion: pCLE shows potential as an adjunctive bronchoscopic imaging technique in the differential diagnosis of DPLD. Structured and quantitative analysis of the images is required.
Authors: Richard C Newton; Samuel V Kemp; Guang-Zhong Yang; Ara Darzi; Mary N Sheppard; Pallav L Shah Journal: Respiration Date: 2011-03-23 Impact factor: 3.580
Authors: Pallav L Shah; Samuel V Kemp; Richard C Newton; Daniel S Elson; Andrew G Nicholson; Guang-Zhong Yang Journal: Respiration Date: 2016-11-18 Impact factor: 3.580
Authors: Diego Castillo; Simon Walsh; David M Hansell; Martina Vasakova; Vincent Cottin; Goksel Altinisik; Stefano Palmucci; Martina Sterclova; Sergio Harari; Luca Richeldi; Carlo Vancheri; Athol U Wells Journal: Lancet Respir Med Date: 2018-02 Impact factor: 30.700
Authors: Jürgen Hetzel; Fabien Maldonado; Claudia Ravaglia; Athol U Wells; Thomas V Colby; Sara Tomassetti; Jay H Ryu; Oren Fruchter; Sara Piciucchi; Alessandra Dubini; Alberto Cavazza; Marco Chilosi; Nicola Sverzellati; Dominique Valeyre; Dimitri Leduc; Simon L F Walsh; Stefano Gasparini; Martin Hetzel; Lars Hagmeyer; Maik Haentschel; Ralf Eberhardt; Kaid Darwiche; Lonny B Yarmus; Alfonso Torrego; Ganesh Krishna; Pallav L Shah; Jouke T Annema; Felix J F Herth; Venerino Poletti Journal: Respiration Date: 2018-01-09 Impact factor: 3.580
Authors: Edith Silbernagel; David Bondesson; Juergen Behr; Julien Dinkel; Frank Reichenberger Journal: Am J Respir Crit Care Med Date: 2018-04-01 Impact factor: 21.405