In vivoprobe-based confocal laser endomicroscopy in amiodarone-related pneumonia

Salaün, Mathieu; Roussel, F.; Bourg-Heckly, Geneviève; Vever‐Bizet, Christine; Dominique, S.; Genevois, A.; Jounieaux, Vincent; Zalcman, Gérard; Bergot, Emmanuel; Vergnon, Jean‐Michel; Thiberville, Luc

doi:10.1183/09031936.00191911

Cited by 39 publications

(45 citation statements)

References 26 publications

Supporting

Mentioning

Contrasting

Unclassified

Order By: Relevance

“…Endogenous fluorescence allows elastin and tobacco-tar laden macrophages (in smokers) to be identified without the use of intravenous contrast (10). FCFM has already been used to identify malignancy, acute rejection in lung transplantation, amiodarone lung and pulmonary alveolar proteinosis in pilot data (11)(12)(13).…”

Section: Original Articlementioning

confidence: 99%

Fibred confocal fluorescence microscopy in the diagnosis of interstitial lung diseases

et al. 2016

View full text Add to dashboard Cite

Background: Accurate diagnosis is critical to both therapeutic decisions and prognostication in interstitial lung diseases (ILD). However, surgical lung biopsies carry high complication rates. Fibred confocal fluorescence microscopy (FCFM) offers an alternative as it can visualize lung tissue in vivo at the cellular level with minimal adverse events. We wanted to investigate the diagnostic utility, and safety of using FCFM for patients with ILD.Methods: In patients with suspected ILD, FCFM images were obtained from multiple bronchopulmonary segments using a miniprobe inserted through the working channel of a flexible bronchoscope. The procedure was performed under moderate sedation in an outpatient setting. Morphometric measurements and fibre pattern analyses were co-related with computed tomography (CT) findings and patients' final diagnoses based on multi-disciplinary consensus.Results: One hundred and eighty four segments were imaged in 27 patients (18 males) with a median age of 67 years (range, 24-79 years). They were grouped into chronic fibrosing interstitial pneumonia (16 patients) and other ILDs. Six distinct FCFM patterns were observed: normal, increased fibres, densely packed fibres, hypercellular, thickened fibres and others/non-specific. The pattern resembling densely packed fibres was seen in at least one segment in 68.8% patients with chronic fibrosing interstitial pneumonia, but only 36.4% in other ILD (P=0.097). An association between inflammatory patterns on CT and a hypercellular pattern on FCFM was also found (P<0.001).Conclusions: Our study shows the potential of FCFM in classifying ILD, but its role in further diagnosis remains limited.

show abstract

Section: Original Articlementioning

confidence: 99%

Fibred confocal fluorescence microscopy in the diagnosis of interstitial lung diseases

et al. 2016

View full text Add to dashboard Cite

show abstract

“…Previous studies used pCLE to investigate interstitial lung disease, alveolar proteinosis, drug-induced (amiodarone) pneumonitis, lung cancer [15,16,17,18] and, very recently, chronic obstructive pulmonary disease [9]. To the best of our knowledge, this is the first study to investigate the potential clinical usefulness of pCLE in the diagnosis of PJP in HIV+ patients.…”

Section: Discussionmentioning

confidence: 95%

“…Previous studies have reported a minor risk of pneumothorax and chest pain [15] or mild bleeding [19] following pCLE. This was not the case in any of the patients included in our study.…”

Section: Discussionmentioning

confidence: 99%

“…Bronchoscopy is a minimally invasive procedure that allows pCLE but can also obtain respiratory secretions and bronchoalveolar lavage allowing their analyses identifying other potential microorganisms. We do not defend the replacement of lesser invasive techniques but we stress a new inclusion of pCLE indication besides pulmonary aspergillosis, alveolar proteinosis, drug pneumonitis and lung cancer [15,16,17,18,38,39]. …”

Section: Discussionmentioning

confidence: 99%

See 1 more Smart Citation

Usefulness of Bronchoscopic Probe-Based Confocal Laser Endomicroscopy in the Diagnosis of Pneumocystis jirovecii Pneumonia

Shafiek

Fiorentino²,

Cosío³

et al. 2016

Respiration

Self Cite

View full text Add to dashboard Cite

Background: Probe-based confocal laser endomicroscopy (pCLE) is a novel technique that provides in vivo microscopic imaging of the distal lung. We hypothesized that the intra-alveolar exudates characterizing Pneumocystis jirovecii pneumonia (PJP) can be identified by pCLE in vivo and help in its diagnosis. Objectives: We aimed toassess the usefulness of pCLE for the in vivo diagnosis of PJP. Methods: Thirty-two human immunodeficiency virus (HIV)-positive patients with new pulmonary infiltrates and fever were studied using pCLE. Real-time alveolar images were recorded during the bronchoscopy for off-line analysis by two independent observers. Bronchoalveolar lavage samples were also obtained and processed for microbiology and cytological evaluation, including Grocott stain for P. jirovecii. The sensitivity, specificity, positive predictive value (PPV) and negative predictive value (NPV) of pCLE for the diagnosis of PJP in these patients were calculated. Results: Fourteen patients (44%) were confirmed to have PJP by cultures/staining. pCLE was well tolerated in all patients. It identified intra-alveolar exudates in 13 of them (41%), where 11 of them (85%) had positive Grocott stain for P. jirovecci, with 93% concordance between observers. Sensitivity, specificity, PPV and NPV of pCLE for the diagnosis of PJP were 79, 89, 85 and 84%, respectively. In smokers, these figures improved to be 92, 88, 85 and 94%. Conclusions: pCLE is a quick and safe procedure for on-site diagnosis of PJP in HIV+ patients with excellent specificity and sensitivity mainly in smokers.

show abstract

“…The detachment of the imaging microprobe from other components of the imaging system allows in situ imaging of organs and tissues within a body, which cannot be performed with conventional microscopy. In the last years, the unique capability of real-time, in situ microscopic imaging has led to development of FCM-based approaches for clinical diagnosis in gastrointestinology (Inoue et al, 2005; Kiesslich and Neurath, 2005; Goetz et al, 2006; Anandasabapathy, 2008), pulmonology (Thiberville et al, 2009; Salaun et al, 2013), and urology (Wu et al, 2011). …”

Section: Introductionmentioning

confidence: 99%

Local delivery of fluorescent dye for fiber-optics confocal microscopy of the living heart

et al. 2014

View full text Add to dashboard Cite

Fiber-optics confocal microscopy (FCM) is an emerging imaging technology with various applications in basic research and clinical diagnosis. FCM allows for real-time in situ microscopy of tissue at sub-cellular scale. Recently FCM has been investigated for cardiac imaging, in particular, for discrimination of cardiac tissue during pediatric open-heart surgery. FCM relies on fluorescent dyes. The current clinical approach of dye delivery is based on systemic injection, which is associated with high dye consumption, and adverse clinical events. In this study, we investigated approaches for local dye delivery during FCM imaging based on dye carriers attached to the imaging probe. Using three-dimensional confocal microscopy, automated bench tests, and FCM imaging we quantitatively characterized dye release of carriers composed of open-pore foam only and foam loaded with agarose hydrogel. In addition, we compared local dye delivery with a model of systemic dye delivery in the isolated perfused rodent heart. We measured the signal-to-noise ratio (SNR) of images acquired in various regions of the heart. Our evaluations showed that foam-agarose dye carriers exhibited a prolonged dye release vs. foam-only carriers. Foam-agarose dye carriers allowed reliable imaging of 5–9 lines, which is comparable to 4–8 min of continuous dye release. Our study in the living heart revealed that the SNR of FCM images using local and systemic dye delivery is not different. However, we observed differences in the imaged tissue microstructure with the two approaches. Structural features characteristic of microvasculature were solely observed for systemic dye delivery. Our findings suggest that local dye delivery approach for FCM imaging constitutes an important alternative to systemic dye delivery. We suggest that the approach for local dye delivery will facilitate clinical translation of FCM, for instance, for FCM imaging during pediatric heart surgery.

show abstract

In vivoprobe-based confocal laser endomicroscopy in amiodarone-related pneumonia

Cited by 39 publications

References 26 publications

Fibred confocal fluorescence microscopy in the diagnosis of interstitial lung diseases

Fibred confocal fluorescence microscopy in the diagnosis of interstitial lung diseases

Usefulness of Bronchoscopic Probe-Based Confocal Laser Endomicroscopy in the Diagnosis of <b><i>Pneumocystis jirovecii</i></b> Pneumonia

Local delivery of fluorescent dye for fiber-optics confocal microscopy of the living heart

Contact Info

Product

Resources

About