Assessment of needle-based confocal laser endomicroscopy (nCLE) as a tool for real-time diagnosis of non-small cell lung cancer.

Background: The widespread deployment of screening programs has increased the number of suspected pulmonary nodules diagnosed. The main objective of this retrospective study was to evaluate the concordance between needle-based confocal laser endomicroscopy (nCLE) image patterns and pathology reports. Methods: In this retrospective study, we reviewed all cases of endobronchial navigational bronchoscopy (ENB) performed using the nCLE system as a guide for injecting a dye marker or for biopsy of a lung nodule. All surgeries were performed at the Thoracic Surgery Department, University Hospital Nancy, France, between June and October 2023. All navigation procedures were performed under general anesthesia by a senior resident supervised by a senior surgeon, and endobronchial positioning assistance was provided by using the nCLE probe. Results: A total of 30 patients were included in this study. The median size of the suspicious lesions was 16 mm [interquartile range (IQR), 13 mm]. The average time the nCLE system was in contact with the lesion was 5 minutes (IQR, 5 minutes). In 22/30 patients, dark, enlarged pleomorphic cells were visualized, and for one patient, a mix of dark clusters and dark enlarged pleomorphic cells was visualized, leading to a diagnosis of cancer in 22/23 patients (95.6%). For five patients, dark clusters were visualized, resulting in a diagnosis of cancer in 100% of patients. Pathology was performed for 6/30 patients/21 (20%) by endobronchial biopsy and for 24 patients by surgical resection of the suspicious lesion (80%). Conclusions: By retrospectively analyzing the nCLE lung cancer criteria published by Wijmans