In patients with suspected malignant pleural mesothelioma, confocal laser endomicroscopy (CLE) holds promise as a guidance tool for use in pleural biopsies and can help distinguish pleural abnormalities from pleural fibrosis, according to study results published in CHEST.

The study included patients from multiple centers who were scheduled to undergo pleural biopsies for suspected malignant pleural mesothelioma ( Identifier: NCT02689050). Prior to the procedure, 2.5 ml fluorescein was administered intravenously to the patients. Histology was correlated with in vivo through the needle CLE imaging of the pleura and ex vivo CLE imaging of the biopsies. Characteristic CLE patterns were identified for hyaline stroma, fibrotic pleura, pleuritis, and malignant pleural mesothelioma epithelial and sarcomatoid type by a pathologist with expertise in mesothelioma.

In 15 patients, CLE imaging was obtained from the following diagnostic pleural biopsy procedures: thoracoscopy (n=3), surgical excision (n=3) computed tomography (n=4), ultrasound (n=9), and esophageal ultrasound-guided (n=1) procedures. In addition, researchers obtained CLE videos (n=89) and corresponding pleural biopsies (n=105). There were no adverse events related to imaging. CLE imaging was effective for distinguishing between tumor deposits of malignant pleural mesothelioma and pleural fibrosis (interobserver agreement, 0.56; 95% CI, 0.49-0.64).

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Study limitations included the small number of biopsies obtained, as well as the lack of a control group.

Based on their findings, the investigators concluded that “CLE has potential as a real-time biopsy guidance tool, in order to increase the rate of representative pleural biopsies by identification of areas with malignancy.”

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Disclosures: Drs Annema and Wijams report financial relationships with Mauna Kea Technologies.


Wijmans L, Baas P, Sieburgh TE, et al. Confocal laser endomicroscopy (CLE) as a guidance tool for pleural biopsies in malignant pleural mesothelioma [published online May 7, 2019]. CHEST. doi:10.1016/j.chest.2019.04.090