Bronchoscopic Journey of in vivo Real-Time Microscopic Imaging in ILD: A Case Series

Background: Patients with interstitial lung diseases (ILDs) frequently present with nondiagnostic high-resolution CT (HRCT) scan and bronchoalveolar lavage (BAL) results, resulting in the need for invasive surgical or cryo-lung biopsy that is associated with significant morbidity. Confocal laser end...

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Published in:Respiration Vol. 101; no. 11; pp. 1006 - 1014
Main Authors: Wijmans, Lizzy, Kalverda, Kirsten, de Bruin, Daniel, Brinkman, Paul, van den Berk, Inge, Roelofs, Joris J.T.H., Jonkers, René, Bonta, Peter I., Annema, Jouke
Format: Journal Article
Language:English
Published: Basel, Switzerland S. Karger AG 01.11.2022
Subjects:
Biopsy - methods
Bronchoalveolar Lavage
Bronchoscopy
Bronchoscopy - methods
CT imaging
Diagnosis
Humans
Interventional Pulmonology
Lung diseases, Interstitial
Lung Diseases, Interstitial - diagnosis
Methods
Microscopy, Medical
Retrospective Studies
Netherlands
Bronchoscopy
Histology
Optical coherence tomography
Confocal laser endomicroscopy
Interstitial lung disease
ISSN:0025-7931, 1423-0356, 1423-0356
Online Access:Get full text
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Summary:Background: Patients with interstitial lung diseases (ILDs) frequently present with nondiagnostic high-resolution CT (HRCT) scan and bronchoalveolar lavage (BAL) results, resulting in the need for invasive surgical or cryo-lung biopsy that is associated with significant morbidity. Confocal laser endomicroscopy (CLE) and optical coherence tomography (OCT) are high-resolution laser and light-based techniques that provide real-time imaging of the alveolar compartment during bronchoscopy with a different depth and field of view. Objectives: The aim of the study was to correlate OCT and CLE imaging to HRCT imaging in ILD. Methods: This is a retrospective case series of 20 ILD patients who underwent alveolar CLE and OCT imaging during a standard bronchoscopy with BAL, followed by a lung biopsy when indicated. CLE and OCT imaging were compared to four main HRCT patterns and histology. The final diagnosis was based on the multidisciplinary discussion diagnosis. Results: Bronchoscopic CLE and OCT imaging were feasible and safe and provided additional high-detailed anatomical information compared to the HRCT. Bronchoscopic real-time CLE was capable of identification of “alveolar cells” (ground glass opacities) and lung fibrosis (increased alveolar elastin fibers). Bronchoscopic real-time OCT allowed for visualization of “patchy fibrotic disease”, “honeycombing” (microcysts), and mucosal granulomas in the airways. Conclusions: Bronchoscopic CLE and OCT of the alveolar compartment is feasible and safe and enables minimally invasive, high-resolution detection of specific ILD features with the potential to improve ILD diagnostics and monitoring and decrease the need for surgical or cryo-lung biopsies.
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ISSN:0025-7931
1423-0356
1423-0356
DOI:10.1159/000526045