Confocal Laser Endomicroscopy

Confocal Laser Endomicroscopy

Yrd Doç Dr Sulhattin ArslanCumhuriyet Üniversitesi Tıp Fakültesi Göğüs

Hastalıkları AD, Sivas

HERHANGİ BİR KURUM YA DA ŞAHIS İLE BİR ÇIKAR İLİŞKİM YOKTUR

CONFOCAL LASER ENDOMİCROSCOPY

• Confocal endomicroscopes aim at providing microscopic imaging of a living tissue to the clinician• ‘‘Optical biopsies’’


• Such systems have recently been applied to the explorations of several organs, including the upper and the lower GIS, pancreato-biliary tract

• More recently to the proximal and distal airways in vivo


• Commercially;

1- Optisan/Pentax Microendoscopy,Japan2- CellVizio-LungR /Mauna Kea Tech, French

OPTİSAN/PENTAX ENDOMİCROSCOPY

• Optiscan endomicroscopy of the gastrointestinal tract provide images very close to conventional histology

OPTİSAN/PENTAX ENDOMİKROSKOPİ

• Two potential drawbacks explain why this system is not yet available for the respiratory tract imaging;

1.Large diameter of distal 2.Scanning rate is too slow (1 frame/second)Respiratory system is more mobile

CELLVİZİO-LUNGR

• A probe-based confocal laser endomicroscopy

• Designed for imaging of the internal micro-structures of anatomical tissues

CELLVİZİO-LUNGR

• The device has a laser scanning technology adapted to image by means of an optical fiber bundle

CELLVİZİO-LUNGR

• Uses the principle of proximal scanning• Carries the light to the scanned area by fiber

bundle and miniprobe• The light delivery, scanning, spectral filtering,

and imaging systems are located at the proximal part of the device• The distal part includes a connector which

transfers the image to the miniprobe and the laser scanning unit


Confocal microscopy helps to image in vivo cells and tissues by obtaining lateral and axial resolution

• The illumination and detection systems being conjugated on the same focal plane, are termed confocal


488 nm wavelength is used for imaging• Microspectrometer experiments have clearly

demonstrated that the main fluorescence signal emitted after 488 nm excitation from both bronchial and alveolar human systems originates from the elastin component of the tissue

Elastin fibers


• 1.4 nm diameter miniprobe • 488-nm-wavelength laser light• 9-12 frames per second• Depth of focus of 0 to 50 micron • Field of view of 600 3 600 micron• Lateral resolution of 3.5 μm• Up to 30,000 microfibers Histological quality image

MİNİPROBE• The miniprobe is applied onto the bronchial wall

surface or advanced into a distal bronchiole down to the acinus and obtains images from these anatomical areas.

The basement membrane of the proximal airways Peripheral interstitial Alveolar wall Macrophage Bronchial epithelial layer Peripheral lung nodules


• Alveolar septal wall• Microvessels • Macrophage• Basement membrane


• After the procedure Hemorrhage (because of miniprobe) there is no need to intervention


• Contrast agent Intravenous: Fluorescein %1,4 emesis, hypotension and epigastric pain

Topical: Acriflavine, Metilen blue

IMAGING OF THE PROXIMAL BRONCHI• Under local anesthesia• Miniprobe is introduced into the working channel of the

bronchoscope• The depth of focus being 50 mm below the contact surface,

subepithelial connective tissue lamina densa, lamina reticularis

480 nm fluoreskeine bronchial basement membrane Benign, malignant/premalignant bronchial alterations

FROM THE DİSTAL BRONCHIOLES DOWN TO THE LUNG ACINI

• Elastin represents up to 50% of the peripheral lung connective tissue fibers

• Bronchial wall, alveolus, extra-alveolar microvessels

http://www.em-consulte.com/rmr/module/displayarticle/article/257686/iconosup/fig4





CONFOCAL LASER ENDOMİCROSCOPY FOR DİAGNOSİNG LUNG CANCER İN VİVO

32 patients with suspected malignancies underwent bronchoscopy with endomicroscopy using acriflavine

75,522 confocal images from 56 different locations Neoplastic changes: Sensitivity, 96 % Specificity, 87 % Accuracy, 91 % Fuchs et al. Eur Respir J. 2012 Sep 20. [Epub ahead of print]





Peripheral pulmonary nodule Interstitial pathology Bronchi and bronchial structure Chronic rejection after lung

transplantation


LİMİTATİONS Can not obtain tissue sample

Only elastin fiber image


TEŞEKKÜR EDERİM

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Confocal Laser Endomicroscopy