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HUMAN IN VIVO CONFOCAL MICROSCOPIC IMAGING OF THE DISTAL BRONCHIOLES AND ALVEOLI

Rouen University Hospital, Rouen, France

PURPOSE: Fibered confocal fluorescence microscopy (FCFM), also refered as Cellvizio-Lung ® (Mauna Kea Technologies, France) is a new technique that produces microscopic imaging in a living tissue, through a 1.4 mm fiberoptic miniprobe that can be introduced into the working channel of the bronchoscope. The system produces real-time imaging of endogenous fluorophores with a 5 µm lateral resolution and a field of view of 600x600 µm. The purpose of this study was to analyze the microstructure of the distal airways in vivo using FCFM during bronchoscopy.

METHODS: 64 individuals including 20 healthy volunteers have been included in the study (National Clinical Trial Id: 00377338). All procedures were performed under local anesthesia without sedation. The 4.4mm bronchoscope was blocked distally. The confocal miniprobe was inserted through the working channel, and gently pushed up to the alveolar structures. Four to 9 separate alveolar areas were explored in each patient. Chest radiograph was obtained after the procedure in each case.

RESULTS: No complication occured during or after the procedure. Alveoli were reached from 2.5 to 5 cm from the tip of the bronchoscope according to the segment explored. The technique produced a clear, dynamic, high-resolution microimaging of the respiratory bronchiolar walls, alveolar ducts and sacs, as well as of autofluorescent alveolar macrophages. Thickening of the alveolar walls, distal granulomas and a dense disorganisation of the acinar microstructure were recorded in cases of asbestosis, sarcoidosis, and systemic sclerosis, respectively.

CONCLUSION: Broncho-Alveoscopy using FCFM is a safe and minimally invasive procedure that makes it possible to obtain multiple "optical biopsies"of the periphal lung compartment.

CLINICAL IMPLICATIONS: The technique appears highly promising in diffuse interstitial lung diseases exploration.

DISCLOSURE: Luc Thiberville, No Product/Research Disclosure Information; University grant monies No; Grant monies (from sources other than industry) No; Grant monies (from industry related sources) No; Shareholder No; Employee No; Fiduciary position (of any organization, association, society, etc, other than ACCP No; Consultant fee, speaker bureau, advisory committee, etc. No; Other I share a pending patent on Alveoscopy with Mauna Kea Technologies