Mini-Invasive Pleural Probe-Based Confocal Laser Endomicroscopy for Malignant Pleural Effusion Diagnosis

Area of Science:

• Pulmonology
• Oncology
• Medical Imaging

Background:

• Probe-based confocal laser endomicroscopy (pCLE) enables real-time cellular-level imaging of tissues.
• pCLE has shown potential in differentiating malignant from benign pleura and identifying malignant cells in pleural fluids.
• Conventional pleural fluid cytology has limited sensitivity for diagnosing malignant pleural effusion.

Purpose of the Study:

• To evaluate the feasibility, safety, and diagnostic yield of mini-invasive, close-biopsy pleural pCLE.
• To compare the sensitivity and specificity of mini-invasive pleural pCLE with standard pleural fluid cytology for malignant pleural effusion diagnosis.

Main Methods:

• A single-center prospective trial enrolled patients undergoing medical thoracoscopy for pleural effusion.
• Mini-invasive pleural pCLE was performed using a probe introduced through a specialized needle.
• Seven pCLE criteria were prospectively assessed for diagnostic accuracy in malignant pleural effusion.

Main Results:

• Mini-invasive pleural pCLE was found to be feasible and safe in 52 enrolled patients.
• Pleural fluid cytology detected malignant effusion with 42% sensitivity and 100% specificity.
• Mini-invasive pleural pCLE demonstrated 87% sensitivity and 52% specificity for malignant pleural effusion, with five of seven criteria being significant discriminators.

Conclusions:

• Mini-invasive pleural pCLE is a safe and feasible procedure for diagnosing malignant pleural infiltration.
• The sensitivity of mini-invasive pleural pCLE for malignant pleural infiltration significantly surpasses that of pleural fluid cytology.