Needle-based confocal laser endomicroscopy for real-time granuloma detection

Tess Kramer; Lizzy Wijmans; Saskia van Heumen; Sandeep Bansal; Dawn Jeannerat; Christopher Manley; Martijn de Bruin; Peter I. Bonta; Jouke T. Annema

doi:https://doi.org/10.1111/resp.14542

Needle-based confocal laser endomicroscopy for real-time granuloma detection

Tess Kramer, Lizzy Wijmans, Saskia van Heumen, Sandeep Bansal, Dawn Jeannerat, Christopher Manley, Martijn de Bruin, Peter I. Bonta, Jouke T. Annema

Research output: Contribution to journal › Article › Academic › peer-review

1 Citation (Scopus)

Abstract

Background and Objective: Needle-based confocal laser endomicroscopy (nCLE) allows real-time microscopic imaging at the needle tip. nCLE malignancy criteria are used for tool-in-lesion confirmation during bronchoscopic lung nodule analysis. However, to date, nCLE criteria for granulomas are lacking. The aim was to identify and validate nCLE granuloma criteria and assess if blinded raters can distinguish malignant from granulomatous nCLE videos. Methods: In patients with suspected sarcoidosis, nCLE-imaging of mediastinal lymph nodes was performed during endoscopic ultrasound procedures, followed by needle aspiration. nCLE granuloma criteria were identified by comparison with pathology and final diagnoses. Additionally, nCLE-videos of granulomatous lung nodules part of prospective trials and clinical care were compared to the proposed nCLE granuloma criteria. Blinded raters validated nCLE videos of sarcoid and reactive mediastinal lymph nodes and malignant and granulomatous lung nodules twice. Results: Granuloma criteria were identified (brighter-toned, homogeneous and well-demarcated lesions) based on nCLE-imaging in 14 sarcoidosis patients. Raters evaluated 26 nCLE-videos obtained in lymph nodes (n = 15 sarcoidosis; n = 11 reactive and total of 260 ratings). Granuloma criteria were recognized with 88% accuracy. The inter-observer (κ = 0.63, 95% CI 0.54–0.72) and intra-observer reliability (κ = 0.70 ± 0.06) were substantial. Based on 12 nCLE-videos obtained in lung nodules (n = 4 granulomas, n = 6 malignancy, n = 2 malignancy + granulomas and total of 120 ratings) granuloma and malignancy criteria were recognized with 92% and 75% accuracy. Conclusion: nCLE imaging facilitates real-time granuloma visualization. Blinded raters accurately and consistently recognized granulomas on nCLE-imaging and distinguished nCLE granuloma criteria from malignancy. Our data show the potential of nCLE as a real-time bronchoscopic guidance tool for lung nodule analysis.

Original language	English
Pages (from-to)	934-941
Number of pages	8
Journal	Respirology (Carlton, Vic.)
Volume	28
Issue number	10
Early online date	2023
DOIs	https://doi.org/10.1111/resp.14542
Publication status	Published - Oct 2023

Keywords

bronchoscopy and interventional techniques
cytology
histology
nCLE
needle-based confocal laser endomicroscopy
radiology and other imaging
real-time granuloma detection
sarcoidosis

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https://doi.org/10.1111/resp.14542

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@article{2ac7574adb864389b92407ec37aa75af,

title = "Needle-based confocal laser endomicroscopy for real-time granuloma detection",

abstract = "Background and Objective: Needle-based confocal laser endomicroscopy (nCLE) allows real-time microscopic imaging at the needle tip. nCLE malignancy criteria are used for tool-in-lesion confirmation during bronchoscopic lung nodule analysis. However, to date, nCLE criteria for granulomas are lacking. The aim was to identify and validate nCLE granuloma criteria and assess if blinded raters can distinguish malignant from granulomatous nCLE videos. Methods: In patients with suspected sarcoidosis, nCLE-imaging of mediastinal lymph nodes was performed during endoscopic ultrasound procedures, followed by needle aspiration. nCLE granuloma criteria were identified by comparison with pathology and final diagnoses. Additionally, nCLE-videos of granulomatous lung nodules part of prospective trials and clinical care were compared to the proposed nCLE granuloma criteria. Blinded raters validated nCLE videos of sarcoid and reactive mediastinal lymph nodes and malignant and granulomatous lung nodules twice. Results: Granuloma criteria were identified (brighter-toned, homogeneous and well-demarcated lesions) based on nCLE-imaging in 14 sarcoidosis patients. Raters evaluated 26 nCLE-videos obtained in lymph nodes (n = 15 sarcoidosis; n = 11 reactive and total of 260 ratings). Granuloma criteria were recognized with 88% accuracy. The inter-observer (κ = 0.63, 95% CI 0.54–0.72) and intra-observer reliability (κ = 0.70 ± 0.06) were substantial. Based on 12 nCLE-videos obtained in lung nodules (n = 4 granulomas, n = 6 malignancy, n = 2 malignancy + granulomas and total of 120 ratings) granuloma and malignancy criteria were recognized with 92% and 75% accuracy. Conclusion: nCLE imaging facilitates real-time granuloma visualization. Blinded raters accurately and consistently recognized granulomas on nCLE-imaging and distinguished nCLE granuloma criteria from malignancy. Our data show the potential of nCLE as a real-time bronchoscopic guidance tool for lung nodule analysis.",

keywords = "bronchoscopy and interventional techniques, cytology, histology, nCLE, needle-based confocal laser endomicroscopy, radiology and other imaging, real-time granuloma detection, sarcoidosis",

author = "Tess Kramer and Lizzy Wijmans and {van Heumen}, Saskia and Sandeep Bansal and Dawn Jeannerat and Christopher Manley and {de Bruin}, Martijn and Bonta, {Peter I.} and Annema, {Jouke T.}",

note = "Funding Information: : This research has been made possible by an unrestricted research grant provided by Mrs. P. Dijkema. Research funding Publisher Copyright: {\textcopyright} 2023 The Authors. Respirology published by John Wiley & Sons Australia, Ltd on behalf of Asian Pacific Society of Respirology.",

year = "2023",

month = oct,

doi = "https://doi.org/10.1111/resp.14542",

language = "English",

volume = "28",

pages = "934--941",

journal = "Respirology (Carlton, Vic.)",

issn = "1323-7799",

publisher = "Wiley-Blackwell",

number = "10",

}

TY - JOUR

T1 - Needle-based confocal laser endomicroscopy for real-time granuloma detection

AU - Kramer, Tess

AU - Wijmans, Lizzy

AU - van Heumen, Saskia

AU - Bansal, Sandeep

AU - Jeannerat, Dawn

AU - Manley, Christopher

AU - de Bruin, Martijn

AU - Bonta, Peter I.

AU - Annema, Jouke T.

N1 - Funding Information: : This research has been made possible by an unrestricted research grant provided by Mrs. P. Dijkema. Research funding Publisher Copyright: © 2023 The Authors. Respirology published by John Wiley & Sons Australia, Ltd on behalf of Asian Pacific Society of Respirology.

PY - 2023/10

Y1 - 2023/10

N2 - Background and Objective: Needle-based confocal laser endomicroscopy (nCLE) allows real-time microscopic imaging at the needle tip. nCLE malignancy criteria are used for tool-in-lesion confirmation during bronchoscopic lung nodule analysis. However, to date, nCLE criteria for granulomas are lacking. The aim was to identify and validate nCLE granuloma criteria and assess if blinded raters can distinguish malignant from granulomatous nCLE videos. Methods: In patients with suspected sarcoidosis, nCLE-imaging of mediastinal lymph nodes was performed during endoscopic ultrasound procedures, followed by needle aspiration. nCLE granuloma criteria were identified by comparison with pathology and final diagnoses. Additionally, nCLE-videos of granulomatous lung nodules part of prospective trials and clinical care were compared to the proposed nCLE granuloma criteria. Blinded raters validated nCLE videos of sarcoid and reactive mediastinal lymph nodes and malignant and granulomatous lung nodules twice. Results: Granuloma criteria were identified (brighter-toned, homogeneous and well-demarcated lesions) based on nCLE-imaging in 14 sarcoidosis patients. Raters evaluated 26 nCLE-videos obtained in lymph nodes (n = 15 sarcoidosis; n = 11 reactive and total of 260 ratings). Granuloma criteria were recognized with 88% accuracy. The inter-observer (κ = 0.63, 95% CI 0.54–0.72) and intra-observer reliability (κ = 0.70 ± 0.06) were substantial. Based on 12 nCLE-videos obtained in lung nodules (n = 4 granulomas, n = 6 malignancy, n = 2 malignancy + granulomas and total of 120 ratings) granuloma and malignancy criteria were recognized with 92% and 75% accuracy. Conclusion: nCLE imaging facilitates real-time granuloma visualization. Blinded raters accurately and consistently recognized granulomas on nCLE-imaging and distinguished nCLE granuloma criteria from malignancy. Our data show the potential of nCLE as a real-time bronchoscopic guidance tool for lung nodule analysis.

AB - Background and Objective: Needle-based confocal laser endomicroscopy (nCLE) allows real-time microscopic imaging at the needle tip. nCLE malignancy criteria are used for tool-in-lesion confirmation during bronchoscopic lung nodule analysis. However, to date, nCLE criteria for granulomas are lacking. The aim was to identify and validate nCLE granuloma criteria and assess if blinded raters can distinguish malignant from granulomatous nCLE videos. Methods: In patients with suspected sarcoidosis, nCLE-imaging of mediastinal lymph nodes was performed during endoscopic ultrasound procedures, followed by needle aspiration. nCLE granuloma criteria were identified by comparison with pathology and final diagnoses. Additionally, nCLE-videos of granulomatous lung nodules part of prospective trials and clinical care were compared to the proposed nCLE granuloma criteria. Blinded raters validated nCLE videos of sarcoid and reactive mediastinal lymph nodes and malignant and granulomatous lung nodules twice. Results: Granuloma criteria were identified (brighter-toned, homogeneous and well-demarcated lesions) based on nCLE-imaging in 14 sarcoidosis patients. Raters evaluated 26 nCLE-videos obtained in lymph nodes (n = 15 sarcoidosis; n = 11 reactive and total of 260 ratings). Granuloma criteria were recognized with 88% accuracy. The inter-observer (κ = 0.63, 95% CI 0.54–0.72) and intra-observer reliability (κ = 0.70 ± 0.06) were substantial. Based on 12 nCLE-videos obtained in lung nodules (n = 4 granulomas, n = 6 malignancy, n = 2 malignancy + granulomas and total of 120 ratings) granuloma and malignancy criteria were recognized with 92% and 75% accuracy. Conclusion: nCLE imaging facilitates real-time granuloma visualization. Blinded raters accurately and consistently recognized granulomas on nCLE-imaging and distinguished nCLE granuloma criteria from malignancy. Our data show the potential of nCLE as a real-time bronchoscopic guidance tool for lung nodule analysis.

KW - bronchoscopy and interventional techniques

KW - cytology

KW - histology

KW - nCLE

KW - needle-based confocal laser endomicroscopy

KW - radiology and other imaging

KW - real-time granuloma detection

KW - sarcoidosis

UR - http://www.scopus.com/inward/record.url?scp=85167605636&partnerID=8YFLogxK

U2 - https://doi.org/10.1111/resp.14542

DO - https://doi.org/10.1111/resp.14542

M3 - Article

C2 - 37562791

SN - 1323-7799

VL - 28

SP - 934

EP - 941

JO - Respirology (Carlton, Vic.)

JF - Respirology (Carlton, Vic.)

IS - 10

ER -

Needle-based confocal laser endomicroscopy for real-time granuloma detection

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Keywords

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