Abstract
Several aspects of normal alveolar tissue in probe-based confocal laser endomicroscopy (pCLE) have been elucidated; a description of the alveoloscopic findings in different pulmonary disorders is still largely lacking.
In a prospective study, we evaluated 40 lung transplant recipients using probe-based confocal laser endomicroscopy (pCLE) preceding BAL and transbronchial lung biopsy (TBLB) during bronchoscopy. In 6 patients (15%) acute rejection (AR) was diagnosed using TBLB. The recordings of the pCLE images were digitally processed and analyzed for the following parameters: alveolar duct diameter, alveolar elastin thickness, macrophage diameter, number of macrophages per microscopic field and quantification of the autofluorescence signal of macrophages.
In 5 out of 6 AR cases, a diffuse infiltration of autofluorescent cells with a mean diameter of 26.2±13.3μm, was recognized in all examined segments. The number of macrophages per microscopic field and their autofluorescence intensity were significantly higher in the AR group than in the non-AR group (p < 0.001 and p = 0.03 respectively). In all affected segments there appeared to be more than 100 cells per microscopic field, frequently presenting as clustering cells. The elastin network in the alveolar ducts of AR appeared to be of a normal architecture (alveolar elastin thickness mean 8.3±4.9μm, alveolar mouth diameter mean 371±131μm), and did not differ from the patient group without AR (7.8±3.7μm and 323±89 μm, respectively).
In the lung transplant recipient group studied, our preliminary findings suggest that pCLE is able to detect an alveoloscopic pattern that might correlate with AR.
- © 2011 ERS