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In vivo probe-based confocal laser endomicroscopy in amiodarone-related pneumonia
Mathieu Salaün1, Francis Roussel, Geneviève Bourg-Heckly
1Rouen University Hospital, Rouen, F-76031.
Abstract:
Probe-based confocal laser endomicroscopy (pCLE) allows microscopic imaging of the alveoli during bronchoscopy. The objective of the study was to assess the diagnostic accuracy of pCLE for amiodarone-related pneumonia (AMR-IP). Alveolar pCLE was performed in 36 nonsmoking patients, including 33 consecutive patients with acute or subacute interstitial lung disease (ILD), of which 17 were undergoing treatment with amiodarone, and three were amiodarone-treated patients without ILD. Nine out of 17 patients were diagnosed with high-probability AMR-IP (HP-AMR-IP) by four experts, and three separate observers. Bronchoalveolar lavage findings did not differ between HP-AMR-IP and low-probability AMR-IP (LP-AMR-IP) patients. In HP-AMR-IP patients, pCLE showed large (>20 μm) and strongly fluorescent cells in 32 out of 38 alveolar areas. In contrast, these cells were observed in only two out of 39 areas from LP-AMR-IP patients, in one out of 59 areas from ILD patients not receiving amiodarone and in none of the 10 areas from amiodarone-treated patients without ILD (p<0.001; HP-AMR-IP versus other groups). The presence of at least one alveolar area with large and fluorescent cells had a sensitivity, specificity, negative predictive value and positive predictive value for the diagnosis of AMR-IP of 100%, 88%, 100% and 90%, respectively. In conclusion, pCLE appears to be a valuable tool for the in vivo diagnosis of AMR-IP in subacute ILD patients.
Insights
Probe-based confocal laser endomicroscopy (pCLE) accurately diagnoses amiodarone-related pneumonia (AMR-IP). This advanced imaging technique identified characteristic fluorescent cells in patients with AMR-IP, aiding in early and precise diagnosis.
Area of Science:
- Pulmonology
- Medical Imaging
- Toxicology
Background:
- Amiodarone is a common medication for cardiac arrhythmias.
- Amiodarone can cause interstitial pneumonia (IP), a serious side effect.
- Accurate diagnosis of amiodarone-related interstitial pneumonia (AMR-IP) is crucial for patient management.
Purpose of the Study:
- To evaluate the diagnostic accuracy of probe-based confocal laser endomicroscopy (pCLE) for amiodarone-related pneumonia (AMR-IP).
- To assess the utility of pCLE in differentiating AMR-IP from other interstitial lung diseases (ILD).
Main Methods:
- Alveolar pCLE was performed in 36 patients, including those with ILD treated with amiodarone.
- Patients were categorized into high-probability AMR-IP (HP-AMR-IP) and low-probability AMR-IP (LP-AMR-IP) groups.
- pCLE findings, specifically large, fluorescent cells, were analyzed and compared across groups.
Main Results:
- HP-AMR-IP patients showed significantly higher prevalence of large, fluorescent cells in alveolar areas compared to other groups (p<0.001).
- The presence of these cells demonstrated high diagnostic accuracy for AMR-IP: 100% sensitivity, 88% specificity, 100% NPV, and 90% PPV.
- Bronchoalveolar lavage findings did not differentiate between HP-AMR-IP and LP-AMR-IP.
Conclusions:
- pCLE is a valuable tool for the in vivo diagnosis of amiodarone-related pneumonia in patients with subacute interstitial lung disease.
- pCLE offers high sensitivity and specificity in identifying AMR-IP, potentially improving patient outcomes.
- This imaging modality can aid clinicians in making timely and accurate diagnoses, guiding treatment decisions.
