Abstract
Background: In patients with interstitial lung diseases (ILD), ground glass opacities (GGO) can represent the main pattern on HRCT-scans. Confocal laser endomicroscopy (CLE) enables real-time microscopic imaging during bronchoscopy of the elastic fibers and autofluorescent cellular structures of the alveolar compartment. We hypothesize that CLE can distinguish the underlying cause (partially filled alveoli or fine fibrosis) of GGO on HR-CT scans.
Methods: Twenty non/former smokers with ILD scheduled for lung (cryo/surgical) biopsies, underwent in-vivo CLE imaging during bronchoscopy with subsequent lung (cryo)biopsies and ex-vivo CLE imaging. Patients with GGO on HR-CT scan were selected for analysis.
Results: In 9 patients GGO were present, 4 patients had a ‘cellular pattern’ on CLE imaging corresponding to intralobular cellular infiltrates (final diagnosis: LIP, DIP, cellular NSIP). CLE-imaging in 5 patients showed an ‘increased fiber pattern, with derangement of alveolar architecture’ corresponding to fibrotic lung tissue areas on biopsy samples (final diagnosis:cHP, fNSIP) (Fig1). No adverse events occurred.
Conclusion: In non /former smokers with a predominant GGO on HRCT scan, CLE seems to differentiate between the two key underlying histological patterns. Therefore, in the diagnostic workup of ILD, CLE imaging might reduce the need for risky lung biopsies in this subgroup of ILD patients.
Footnotes
Cite this article as: European Respiratory Journal 2018 52: Suppl. 62, PA3655.
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- Copyright ©the authors 2018