A Novel Method for In Vivo Imaging of Solitary Lung Nodules Using Navigational Bronchoscopy and Confocal Laser Microendoscopy

Abstract

Solitary pulmonary nodules (SPN) have become increasingly prevalent and diagnostic management remains challenging. We demonstrate a novel technique in which probe-based confocal endomicroscopy (pCLE) could be performed to microimage SPN in vivo and in realtime. Two confocal wavelengths (488 and 660 nm with methylene blue (MB)) were used for elastin network and cellular imaging, respectively using pCLE in conjunction with r-EBUS and virtual navigation. In the first case, the 1-mm Alveoflex Ò was used to image a metastatic melanoma in a subcentimetric nodule in the right middle lobe. In the next case, a malignant 2-cm nodule in the posterior segment of the upper lobe was imaged using the smaller 0.6-mm Cholangioflex Ò . Lastly, we present a benign case revealing confocal characteristics of a nodular lipid pneumonitis. This reports for the first time the feasibility and utility of pCLE in vivo microimaging of SPN using either the Alveoflex or Cholangioflex miniprobes in addition to 660 nm/MB imaging.

Non-destructive two-photon excited fluorescence imaging identifies early nodules in calcific aortic-valve disease

“…66–68 In addition, confocal microendoscopy probes as small as 0.6 mm in diameter have already been developed. 69 Thus, an endogenous fluorescence-based high-resolution imaging system developed and optimized for mineral deposition detection in human valves is technologically highly feasible. Of course, thorough studies that establish the sensitivity and specificity of this approach will be needed.…”

Bronchoscopy for the diagnosis of peripheral lung lesions

“…Enhancement in current technology is developing at a rapid pace with easier operability of equipment and improved ability for real time confirmation with cone-beam CT and RP-EBUS (52). Development of advanced technologies like optical coherence technology (OCT) and fibered confocal laser microscopy (FCFM) may additionally help in precise selection of the site of sampling (Figure 3) (53,54). In OCT, the backscattering of light is used to attain cross-sectional images of tissue.…”

Needle-based confocal laser endomicroscopy in the diagnosis of peripheral pulmonary nodule: a preliminary report

“…Several studies (1,2) reported that CLE is promising for lung cancer exploration and improving diagnostic yield. Compared to the conventional probe-based confocal laser endomicroscopy (pCLE), the novel needle-based confocal laser endomicroscopy (nCLE) is characterized by a smaller miniprobe (AQ-Flex 19, Mauna Kea Technologies, Paris, France) with an external diameter of 0.9 mm, a resolution of 3.5 µm and a penetration depth of 40 to 50 µm.…”