Peripheral Pulmonary Lesions (PPLs)
Conditions
Keywords
peripheral pulmonary lesions, Confocal Laser Endomicroscopy, Rapid On-Site Evaluation, Transbronchial Lung Biopsy, diagnosis
Brief summary
The goal of this observational study is to evaluate the diagnostic efficacy of Confocal Laser Endomicroscopy (CLE) compared to Rapid On-Site Evaluation (ROSE) for ex vivo lung biopsy specimens obtained via bronchoscopy. The main questions it aims to answer are: 1. Does CLE provide diagnostic accuracy comparable to ROSE for the real-time assessment of peripheral pulmonary lesions? 2. What is the level of consistency between CLE-detected malignant architectural patterns and ROSE-identified atypical cells? Participants with peripheral pulmonary lesions (5-50 mm) undergoing navigational bronchoscopy will have their first retrieved biopsy specimen sequentially analyzed. The specimen will undergo CLE scanning first, followed immediately by ROSE cytology, before being fixed for final histopathological examination (the gold standard). CLE and ROSE interpreters will be blinded to the final pathological results and to each other's findings. Diagnostic performance, inter-modality agreement (using Kappa statistics), and procedure times will be analyzed to determine if CLE can serve as a non-consumptive alternative to ROSE.
Interventions
DIAGNOSTIC_TESTEx Vivo Confocal Laser Endomicroscopy (CLE) Imaging and Interpretation
Following navigational bronchoscopy and target confirmation via radial endobronchial ultrasound (r-EBUS) and in vivo CLE, a lung biopsy is performed. The first retrieved specimen is immediately transferred to the CLE workstation. A CLE expert measures the specimen dimensions and then performs a comprehensive surface scan of the intacttissue using a confocal miniprobe. The operator records the time required for setup and imaging. Based exclusively on the real-time microarchitectural patterns (e.g., loss of normal alveolar honeycombing, dense cell clusters), the blinded CLE expert renders a preliminary diagnosis of "benign" or "malignant." Crucially, this intervention is non-consumptive, meaning the tissue remains physically intact and structurally preserved after the scan for the subsequent ROSE procedure.
DIAGNOSTIC_TESTRapid On-Site Evaluation (ROSE) Imaging and Interpretation
Immediately following the completion of the ex vivo CLE imaging on the same biopsy specimen, the tissue undergoes ROSE processing. A ROSE expert (cytopathologist) performs a smear preparation using the CLE-scanned tissue. The specimen is then stained (e.g., Diff-Quik) and evaluated microscopically. The operator records the time required for smear preparation, staining, and interpretation. The blinded ROSE expert assesses the presence of atypical cells or diagnostic material to render a cytological diagnosis of "benign" or "malignant." Unlike the preceding CLE step, this intervention is consumptive, as it requires the physical disruption of the tissue architecture to transfer cellular material onto glass slides.
Sponsors
Guangzhou Medical University
Study design
Observational model
COHORT
Time perspective
PROSPECTIVE
Eligibility
Sex/Gender
ALL
Age
18 Years to No maximum
Healthy volunteers
No
Inclusion criteria
* （1）Imaging Findings: Presence of a peripheral pulmonary lesion (PPL) measuring 5 to 50 mm in maximum diameter on chest CT scan. （2）Clinical Indication: Patients with a clinical indication for diagnostic flexible bronchoscopy and transbronchial biopsy. （3）Consent: Provision of signed and dated written informed consent prior to any study-specific procedures.
Exclusion criteria
* （1）Contraindications to Bronchoscopy: Patients with severe cardiopulmonary insufficiency or any absolute contraindication to flexible bronchoscopy (e.g., severe hypoxemia, unstable angina, or uncontrolled asthma). （2）Coagulopathy: Patients with severe coagulation disorders (e.g., platelets \<50,000/μL, INR \>1.5) not corrected prior to the procedure. （3）Pregnancy/Lactation: Pregnant or lactating women.
Design outcomes
Primary
| Measure | Time frame | Description |
|---|---|---|
| Diagnostic accuracy of ex vivo CLE versus ROSE for malignancy detection in peripheral pulmonary lesions | Intraoperative - within 30 minutes of each biopsy specimen retrieval | Using final histopathology as the gold standard, diagnostic accuracy (proportion of correct benign/malignant classifications) will be calculated for both ex vivo confocal laser endomicroscopy (CLE) and rapid on-site evaluation (ROSE). Sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV), and overall accuracy with 95% confidence intervals will be derived from 2×2 contingency tables for each modality. |
Secondary
| Measure | Time frame | Description |
|---|---|---|
| Diagnostic performance of ex vivo CLE | Intraoperative | Using final histopathology as the gold standard, the sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV) of ex vivo confocal laser endomicroscopy (CLE) for detecting malignancy will be calculated, along with 95% confidence intervals. |
| Diagnostic performance of ROSE | Intraoperative | Using final histopathology as the gold standard, the sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV) of ROSE will be calculated based on touch imprint cytology performed after CLE imaging. |
| Cohen's kappa (κ) for agreement between CLE diagnosis and final histopathology | After final pathology available (within 7-10 working days) | Measures inter-rater/modality concordance beyond chance agreement. |
| Cohen's kappa (κ) for agreement between CLE structural findings and ROSE cytological findings on the same specimen | Intraoperative interpretations, validated post-pathology | Cross-validation of malignant architectural patterns (CLE) vs. presence of atypical cells (ROSE). |
| Procedure time: CLE imaging and interpretation time per specimen | Intraoperative | Measured in seconds/minutes from probe placement to definitive optical diagnosis. |
| Procedure time: ROSE preparation and interpretation time per specimen | Intraoperative | Measured in seconds/minutes from touch imprint/smear to definitive cytological diagnosis. |
Countries
China
Contacts
CONTACTZhenDing You
Outcome results
None listed