First report of probe based confocal laser endomicroscopy during medical thoracoscopy

Our plain-English summary of First report of probe based confocal laser endomicroscopy during medical thoracoscopy, by O. Bonhomme, B. Duysinx, V. Heinen, et al (Respiratory Medicine, 2019).

The study

• Authors: O. Bonhomme, B. Duysinx, V. Heinen, N. Detrembleur, J.L. Corhay, R. Louis
• Journal: Respiratory Medicine
• Published: 2019;147:72-75
• Type of article: Case report
• Cited by: 11 articles, as counted by NIH iCite
• Read it: PubMed · Publisher

Abstract

Probe based confocal laser endomicroscopy (pCLE) is a new optical endoscopic technique, generating fluorescent light emission from the tissue of interest and allowing in vivo live imaging at a cellular level ("optical biopsies"). To the best of our knowledge, this article is the first to present pCLE images during medical thoracoscopy. We present here 3 different patients referred for various health problems. A precise description of pleural cavity pCLE images after intravenous fluorescein injection (a fluorophore) together with corresponding macroscopical and histological studies is performed. This led to the diagnosis of normal pleura in one case, carcinomatous pleuritis in another case and a malignant mesothelioma in the third case. We believe that optical biopsies could help clinicians to make an early diagnosis, thereby allowing rapid therapeutic intervention (talc pleurodesis for example). Furthermore, it could help to guide biopsies when affected zones are not obvious to macroscopic examination. In a near future, new fluorophores could be developed to stain some pathophysiological processes, therapeutic targets, or enzymes activities bringing new insights in endoscopic pleural disease work-up.

Copyright © 2019. Published by Elsevier Ltd.

In plain English

This short report from the Pneumology Department of CHU Liège, Belgium, was a case series of three patients. During medical thoracoscopy (an examination of the chest cavity through a scope), the authors used probe based confocal laser endomicroscopy (pCLE). This is an experimental technique that images tissue at the level of individual cells after an intravenous injection of the dye fluorescein. Biopsies were then taken at the same sites for comparison. A 38-year-old man with a repeatedly collapsed lung had normal pleura on pCLE, and histology confirmed this. A 79-year-old woman with non-small cell lung carcinoma showed disordered cells, and histology confirmed the cancer had spread into the pleura. A third patient was investigated for fluid around the lung of unknown cause. pCLE showed large, irregular cells, and histology with immunohistological studies concluded malignant mesothelioma. The pCLE study took about 5 minutes, and the authors reported no adverse events. The authors concluded the technique is feasible, but noted that only three cases were presented and that larger studies are needed. The article does not mention asbestos exposure for any patient.

We wrote this plain-English summary from the full article with the help of AI, and a second AI model checked each sentence against the article. It is not the authors' wording; the abstract and the article are their own account.

What the study did and found

• Design: case series (short communication) of three patients
• Who was studied: 3 patients undergoing medical thoracoscopy at CHU Liège, Belgium: a 38-year-old man, a 79-year-old woman, and a third patient whose age and sex are not given
• Exposure: No asbestos exposure is reported for any patient. The intervention studied was pCLE imaging after intravenous fluorescein (10%, 5 ml), with biopsies taken at the pCLE sites.
• Main results:
  • Patient 1, a 38-year-old man referred for talc pleurodesis after a third spontaneous pneumothorax: pCLE showed well-organized tissue, and histology confirmed normal pleural mesothelium
  • Patient 2, a 79-year-old woman with recurrent exudative pleural effusion due to non-small cell lung carcinoma: pCLE showed cells of different sizes and shapes with indistinct borders, and histology showed pleural infiltration by non-small cell lung carcinoma
  • Patient 3, investigated for exudative pleural effusion of unknown origin: pCLE showed large cells of different sizes and shapes, and histology after immunohistological studies concluded malignant mesothelioma (figure titled pleural mesothelioma)
  • The pCLE study of the pleural cavity took approximately 5 minutes
  • The authors reported no adverse events
• The authors' conclusion: The authors concluded that this first report of pCLE during medical thoracoscopy shows the technique is feasible, and that larger studies are needed before its place in investigating pleural diseases is defined.
• Limitations the authors state:
  • Only three cases were presented
  • pCLE could not examine the entire pleural cavity because of the probe's small optical area
  • Pleural metastatic carcinomatosis and malignant mesothelioma vary widely in their histology
  • Inflammatory pleural diseases from infectious or autoimmune processes also need to be considered, so further studies are needed for differential diagnosis
  • Biopsy and histopathology remain the gold standard, and large studies comparing pCLE to it are needed to establish diagnostic criteria and accuracy

Topics

The National Library of Medicine indexes this study under subjects our site covers: Lung cancer, Mesothelioma, Pleural plaques and thickening.

Medical terms in this study, explained in our Lexicon: Medical Thoracoscopy, Pleural Cavity, Pleura, Malignant Mesothelioma, Talc Pleurodesis.

Related studies

• Confocal Laser Endomicroscopy as a Guidance Tool for Pleural Biopsies in Malignant Pleural Mesothelioma — L. Wijmans, P. Baas, et al. (2019)
• Success rate of medical thoracoscopy and talc pleurodesis in malignant pleurisy: A single-centre experience — J. Leemans, C. Dooms, et al. (2018)
• Simultaneous triple fluorescence detection of mRNA localization, nuclear DNA, and apoptosis in cultured cells using confocal scanning laser microscopy — W.P. Davis, Y.M. Janssen, et al. (1997)
• Multifluorescence labeling techniques and confocal laser scanning microscopy on lung tissue — M. Stern, D.J. Taatjes, et al. (2006)
• The safety of medical thoracoscopy in a group at high risk for complications — M. Metintas, G. Ak, et al. (2013)
• Outcomes and complications following medical thoracoscopy — F.J. Brims, M. Arif, et al. (2012)

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