Needle-based confocal laser endomicroscopy (nCLE) for real-time diagnosing and staging of lung cancer

Objectives Diagnosing lung cancer in the absence of endobronchial abnormalities is challenging. Needle-based confocal laser endomicroscopy (nCLE) enables real-time microscopic imaging of cells. We assessed the feasibility and safety of using nCLE for real time identification of lung cancer Materials and methods In patients with suspected or proven lung cancer scheduled for endoscopic ultrasound (EUS), lung tumours and mediastinal lymph nodes were imaged with nCLE before fine needle aspiration (FNA) was performed. nCLE lung cancer characteristics were identified by comparison with pathology. Multiple blinded raters validated CLE videos of lung tumours and mediastinal nodes twice. Results EUS-nCLE-FNA was performed in 22 patients with suspected or proven lung cancer in whom 27 lesions (6 tumours, 21 mediastinal nodes) were evaluated without complications. Three nCLE-lung cancer criteria (enlarged pleomorphic cells, dark clumps, directional streaming) were identified. Accuracy of nCLE imaging for detecting malignancy in tumours and metastatic lymph nodes was 90% and 89% respectively. Both interobserver (mean IOA (k=0.68 (95% CI: 0.66–0.70)) and intra-observer agreement (mean IOR (k=0.70±0.15)), were substantial. Conclusion Real-time lung cancer detection by endosonography-guided nCLE was feasible and safe. Lung cancer characteristics were accurately recognised.