title: In vivo probe-based confocal laser endomicroscopy in amiodarone-related pneumonia.
abstract: Probe-based confocal laser endomicroscopy (pCLE) allows microscopic imaging of the alveoli during bronchoscopy. The objective of the study was to assess the diagnostic accuracy of pCLE for amiodarone-related pneumonia (AMR-IP). Alveolar pCLE was performed in 36 nonsmoking patients, including 33 consecutive patients with acute or subacute interstitial lung disease (ILD), of which 17 were undergoing treatment with amiodarone, and three were amiodarone-treated patients without ILD. Nine out of 17 patients were diagnosed with high-probability AMR-IP (HP-AMR-IP) by four experts, and three separate observers. Bronchoalveolar lavage findings did not differ between HP-AMR-IP and low-probability AMR-IP (LP-AMR-IP) patients. In HP-AMR-IP patients, pCLE showed large (>20 μm) and strongly fluorescent cells in 32 out of 38 alveolar areas. In contrast, these cells were observed in only two out of 39 areas from LP-AMR-IP patients, in one out of 59 areas from ILD patients not receiving amiodarone and in none of the 10 areas from amiodarone-treated patients without ILD (p<0.001; HP-AMR-IP versus other groups). The presence of at least one alveolar area with large and fluorescent cells had a sensitivity, specificity, negative predictive value and positive predictive value for the diagnosis of AMR-IP of 100%, 88%, 100% and 90%, respectively. In conclusion, pCLE appears to be a valuable tool for the in vivo diagnosis of AMR-IP in subacute ILD patients.
authors.affiliation: Rouen University Hospital, Rouen, F-76031.
authors.forename: Mathieu
authors.initials: M
authors.lastname: Salaün
authors.forename: Francis
authors.initials: F
authors.lastname: Roussel
authors.forename: Geneviève
authors.initials: G
authors.lastname: Bourg-Heckly
authors.forename: Christine
authors.initials: C
authors.lastname: Vever-Bizet
authors.forename: Stéphane
authors.initials: S
authors.lastname: Dominique
authors.forename: Anne
authors.initials: A
authors.lastname: Genevois
authors.forename: Vincent
authors.initials: V
authors.lastname: Jounieaux
authors.forename: Gérard
authors.initials: G
authors.lastname: Zalcman
authors.forename: Emmanuel
authors.initials: E
authors.lastname: Bergot
authors.forename: Jean-Michel
authors.initials: JM
authors.lastname: Vergnon
authors.forename: Luc
authors.initials: L
authors.lastname: Thiberville
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D005260:Female; D006801:Humans; D008297:Male; D000638:Amiodarone / Q000009:adverse effects; D018893:Bronchoalveolar Lavage; D001999:Bronchoscopy / Q000295:instrumentation / Q000379:methods; D005456:Fluorescent Dyes / Q000737:chemistry; D007834:Lasers; D008168:Lung / Q000187:drug effects; D017563:Lung Diseases, Interstitial / Q000139:chemically induced; D018613:Microscopy, Confocal / Q000379:methods; D015588:Observer Variation; D011014:Pneumonia / Q000139:chemically induced; D011237:Predictive Value of Tests; D011336:Probability; D011446:Prospective Studies; D015203:Reproducibility of Results; D012680:Sensitivity and Specificity; D013050:Spectrometry, Fluorescence; D014665:Vasodilator Agents / Q000009:adverse effects
chemical_list: D000638:Amiodarone; D005456:Fluorescent Dyes; D014665:Vasodilator Agents