Impact Confocal laser endomicroscopy (pCLE) findings on long-term outcome in interstitial lung diseases (ILD)

Using pCLE, the lung parenchyma can be visualized in vivo during bronchoscopy and used for the differential diagnosis of ILD. Therefore, a semi-quantitative analysis of pCLE images based on 4 criteria (loaded alveolar macrophages (AM), distortion, density, consolidation) was proposed (Silbernagel et aL SVLDL 2022). We analyzed the impact of pCLE findings on long-term outcome in ILD. Between November 2013 and 2016, pCLE was performed in 51 patients during bronchoscopy for ILD diagnosis (1). We performed a follow-up in the course and association with the initial pCLE images in 39 patients (IPF =10; IPAF =2; COP=10; Amiodarone=3; EAA=5; NSIP=8; MCTD-ILD=1). The mean observation period was 88 months, during which time 20 patients died, 16 are currently alive. With initial detection of AM using pCLE, long-term mortality was 40% (N= 4; 10/4), while mortality in patients without AM was 60% (N= 16; 26/16). This results in a median survival of 50.5 months for AM = 1 and 46 months for AM = 0) The decrease in VC after 6 months correlates with the severity of tissue distortion in the pCLE pattern (p6 months p<0.0079) (Fig. 1).<graphic xlink:href="graphics/73652/1_Figure2.jpg" /> In this small sample, the pCLE criteria AM and distortion at the time of diagnosis might provide an indicator of long-term outcome. Larger and controlled studies are needed to confirm these results.