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Pulmonary Procedures |

Confocal Laser Endomicroscopy to Improve Diagnostic Yield of Pulmonary Nodule and Mass FREE TO VIEW

Pyng Lee, MD; Kay Leong Khoo, MD; Ju Ee Seet, MD
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National University Hospital, Singapore, Singapore


Chest. 2014;145(3_MeetingAbstracts):496A. doi:10.1378/chest.1836311
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Abstract

SESSION TITLE: Bronchoscopy & Interventional Procedures

SESSION TYPE: Slide Presentations

PRESENTED ON: Monday, March 24, 2014 at 09:00 AM - 10:30 AM

PURPOSE: Infection and carcinoma commonly present as pulmonary nodules or masses. Diagnostic workup of these patients requires tissue biopsy since radiological characteristics are non-specific. EBUS combined with navigation bronchoscopy has been shown to increase diagnostic yield, we aim to determine if there are discriminatory pCLE features of benign and malignant etiologies and if it can aid in the selection of site for biopsy.

METHODS: All patients with pulmonary nodules or masses scheduled for bronchoscopy were recruited and bronchoscopic lung biopsy was performed via fluoroscopy. Targeting of pulmonary nodules was aided by navigational planning with Lung Point and radial EBUS. After localization of pulmonary nodule/mass with EBUS, pCLE was performed before bronchoscopic lung biopsy. PCLE was conducted on ex-vivo lung specimens for validation.

RESULTS: Sixteen patients (12 males) with median age 60 years, 10 (62%) were former and current smokers. All pulmonary nodules and masses were solid on CT, only one had eccentric calcification. Histological diagnosis was achieved in all patients: 4 nodules were infectious, 1 organizing pneumonia and 11 lung cancers. Preservation of alveolar architecture, normal alveolar wall thickness and filling of alveolar spaces by macrophages and inflammatory cells were pCLE features of infection. In carcinomas, the alveolar architecture was destroyed with thickening of the elastic fibers. In the patient with organizing pneumonia (OP) and carcinoma, the mass had features of consolidation where pCLE showed preserved alveolar architecture with macrophages and inflammatory cells, and distal destruction of alveoli with thickening of elastin. Bronchoscopic lung biopsy showed OP but he underwent surgery within 3 weeks due to non-resolution of mass. Histology confirmed presence of squamous cell carcinoma adjacent to pneumonia (figures 1-6). These pCLE characteristics were validated on ex-vivo lung specimens.

CONCLUSIONS: We have demonstrated that pCLE correlated with histology and could discriminate pulmonary nodule or mass due to infection and carcinoma.

CLINICAL IMPLICATIONS: pCLE could improve diagnostic yield by identifying appropriate site for biopsy of a pulmonary mass. Finding preserved alveolar architecture with inflammatory cells indicates benign etiology and can be expectantly managed while irregular thickened elastin dictates invasive intervention,

DISCLOSURE: The following authors have nothing to disclose: Pyng Lee, Kay Leong Khoo, Ju Ee Seet

Confocal laser Endomicroscopy probe which allows cellular imaging at 50 microns, the probe is inserted through the working channel of bronchoscope and imaging of cells takes place real time.


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