What is the key question?

• Peripheral lung lesions can be difficult to diagnose with needle access to lesions the major challenge. Several techniques have been suggested to improve the diagnostic yield. This proof of principle study used needle-based confocal laser endomicroscopy (nCLE) to investigate whether this may be a useful technique of improving diagnosis in this group.

What is the bottom line?

• Patients with peripheral lung lesions with high index of suspicion for malignancy were investigated using radial endobronchial ultrasound (rEBUS). nCLE was used to determine whether lesions appeared to be malignant, based on their appearance using that modality.

Why read on?

• The authors noted a good yield from the technique, with 24 of 26 cases returning adequate video to provide an assessment of the tumours. Of these, 23 had lung cancer and 1 had organising pneumonia. Of the 23 patients with lung cancer, 22 were detected using the nCLE technique. The authors suggest that this demonstrates the usefulness of nCLE as a “real-time” diagnostic tool which may reduce the near-miss rate of biopsy.
  There are several limitations to this study including that it does not have a comparator or control group and how this technique compares in terms of yield and diagnostic accuracy against the conventional biopsy approach is an interesting question for the future