{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,7,31]],"date-time":"2026-07-31T18:53:35Z","timestamp":1785524015487,"version":"3.56.0"},"reference-count":25,"publisher":"Wiley","issue":"10","license":[{"start":{"date-parts":[[2023,8,10]],"date-time":"2023-08-10T00:00:00Z","timestamp":1691625600000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by-nc-nd\/4.0\/"}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Respirology"],"published-print":{"date-parts":[[2023,10]]},"abstract":"<jats:title>Abstract<\/jats:title><jats:sec><jats:title>Background and Objective<\/jats:title><jats:p>Needle\u2010based confocal laser endomicroscopy (nCLE) allows real\u2010time microscopic imaging at the needle tip. nCLE malignancy criteria are used for tool\u2010in\u2010lesion confirmation during bronchoscopic lung nodule analysis. However, to date, nCLE criteria for granulomas are lacking. The aim was to identify and validate nCLE granuloma criteria and assess if blinded raters can distinguish malignant from granulomatous nCLE videos.<\/jats:p><\/jats:sec><jats:sec><jats:title>Methods<\/jats:title><jats:p>In patients with suspected sarcoidosis, nCLE\u2010imaging of mediastinal lymph nodes was performed during endoscopic ultrasound procedures, followed by needle aspiration. nCLE granuloma criteria were identified by comparison with pathology and final diagnoses. Additionally, nCLE\u2010videos of granulomatous lung nodules part of prospective trials and clinical care were compared to the proposed nCLE granuloma criteria. Blinded raters validated nCLE videos of sarcoid and reactive mediastinal lymph nodes and malignant and granulomatous lung nodules twice.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>Granuloma criteria were identified (brighter\u2010toned, homogeneous and well\u2010demarcated lesions) based on nCLE\u2010imaging in 14 sarcoidosis patients. Raters evaluated 26 nCLE\u2010videos obtained in lymph nodes (<jats:italic>n<\/jats:italic>\u2009=\u200915 sarcoidosis; <jats:italic>n<\/jats:italic>\u2009=\u200911 reactive and total of 260 ratings). Granuloma criteria were recognized with 88% accuracy. The inter\u2010observer (<jats:italic>\u03ba<\/jats:italic>\u2009=\u20090.63, 95% CI 0.54\u20130.72) and intra\u2010observer reliability (<jats:italic>\u03ba<\/jats:italic>\u2009=\u20090.70\u2009\u00b1\u20090.06) were substantial. Based on 12 nCLE\u2010videos obtained in lung nodules (<jats:italic>n<\/jats:italic>\u2009=\u20094 granulomas, <jats:italic>n<\/jats:italic>\u2009=\u20096 malignancy, <jats:italic>n<\/jats:italic>\u2009=\u20092 malignancy\u2009+\u2009granulomas and total of 120 ratings) granuloma and malignancy criteria were recognized with 92% and 75% accuracy.<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusion<\/jats:title><jats:p>nCLE imaging facilitates real\u2010time granuloma visualization. Blinded raters accurately and consistently recognized granulomas on nCLE\u2010imaging and distinguished nCLE granuloma criteria from malignancy. Our data show the potential of nCLE as a real\u2010time bronchoscopic guidance tool for lung nodule analysis.<\/jats:p><\/jats:sec>","DOI":"10.1111\/resp.14542","type":"journal-article","created":{"date-parts":[[2023,8,11]],"date-time":"2023-08-11T00:19:51Z","timestamp":1691713191000},"page":"934-941","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":13,"title":["Needle\u2010based confocal laser endomicroscopy for real\u2010time granuloma detection"],"prefix":"10.1111","volume":"28","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-2413-2329","authenticated-orcid":false,"given":"Tess","family":"Kramer","sequence":"first","affiliation":[{"name":"Department of Respiratory Medicine Amsterdam UMC, University of Amsterdam  Amsterdam The Netherlands"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Lizzy","family":"Wijmans","sequence":"additional","affiliation":[{"name":"Department of Respiratory Medicine Amsterdam UMC, University of Amsterdam  Amsterdam The Netherlands"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Saskia","family":"van Heumen","sequence":"additional","affiliation":[{"name":"Department of Respiratory Medicine Amsterdam UMC, University of Amsterdam  Amsterdam The Netherlands"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sandeep","family":"Bansal","sequence":"additional","affiliation":[{"name":"The Lung Center, Penn Highlands Healthcare  DuBois Pennsylvania USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Dawn","family":"Jeannerat","sequence":"additional","affiliation":[{"name":"The Lung Center, Penn Highlands Healthcare  DuBois Pennsylvania USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Christopher","family":"Manley","sequence":"additional","affiliation":[{"name":"Department of Respiratory Medicine and Critical Care Fox Chase Cancer Center  Philadelphia Pennsylvania USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Martijn","family":"de Bruin","sequence":"additional","affiliation":[{"name":"Department of Biomedical Engineering and Physics Cancer Center Amsterdam  Amsterdam The Netherlands"},{"name":"Cardiovascular Sciences Amsterdam UMC, University of Amsterdam  Amsterdam The Netherlands"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Peter I.","family":"Bonta","sequence":"additional","affiliation":[{"name":"Department of Respiratory Medicine Amsterdam UMC, University of Amsterdam  Amsterdam The Netherlands"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jouke T.","family":"Annema","sequence":"additional","affiliation":[{"name":"Department of Respiratory Medicine Amsterdam UMC, University of Amsterdam  Amsterdam The Netherlands"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2023,8,10]]},"reference":[{"key":"e_1_2_10_2_1","doi-asserted-by":"publisher","DOI":"10.1164\/rccm.201505-0990OC"},{"key":"e_1_2_10_3_1","doi-asserted-by":"publisher","DOI":"10.1136\/thoraxjnl-2017-211376"},{"key":"e_1_2_10_4_1","doi-asserted-by":"publisher","DOI":"10.1016\/S1470-2045(16)30069-9"},{"key":"e_1_2_10_5_1","doi-asserted-by":"publisher","DOI":"10.1378\/chest.12-2351"},{"key":"e_1_2_10_6_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.chest.2019.12.024"},{"key":"e_1_2_10_7_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.chest.2022.12.044"},{"key":"e_1_2_10_8_1","doi-asserted-by":"publisher","DOI":"10.1097\/MCP.0000000000000929"},{"key":"e_1_2_10_9_1","doi-asserted-by":"publisher","DOI":"10.1159\/000503261"},{"key":"e_1_2_10_10_1","doi-asserted-by":"publisher","DOI":"10.1136\/thoraxjnl-2021-216885"},{"key":"e_1_2_10_11_1","doi-asserted-by":"publisher","DOI":"10.1183\/13993003.01520-2018"},{"key":"e_1_2_10_12_1","doi-asserted-by":"publisher","DOI":"10.1159\/000522515"},{"key":"e_1_2_10_13_1","doi-asserted-by":"publisher","DOI":"10.1111\/resp.14438"},{"key":"e_1_2_10_14_1","doi-asserted-by":"publisher","DOI":"10.1136\/thoraxjnl-2021-216885"},{"key":"e_1_2_10_15_1","doi-asserted-by":"publisher","DOI":"10.1056\/NEJMra2101555"},{"key":"e_1_2_10_16_1","doi-asserted-by":"publisher","DOI":"10.1055\/s-2008-1077296"},{"key":"e_1_2_10_17_1","doi-asserted-by":"publisher","DOI":"10.1164\/rccm.201211-2106IM"},{"key":"e_1_2_10_18_1","doi-asserted-by":"publisher","DOI":"10.1080\/09273940600826471"},{"key":"e_1_2_10_19_1","doi-asserted-by":"publisher","DOI":"10.1159\/000526045"},{"issue":"5","key":"e_1_2_10_20_1","first-page":"437","article-title":"Confocal laser endomicroscopy for the differential diagnosis of ulcerative colitis and Crohn's disease: a pilot study","volume":"47","author":"Tontini GE","year":"2015","journal-title":"Endoscopy"},{"key":"e_1_2_10_21_1","doi-asserted-by":"publisher","DOI":"10.1037\/h0031619"},{"key":"e_1_2_10_22_1","doi-asserted-by":"publisher","DOI":"10.2307\/2529310"},{"key":"e_1_2_10_23_1","doi-asserted-by":"publisher","DOI":"10.1164\/rccm.200605-684OC"},{"key":"e_1_2_10_24_1","doi-asserted-by":"publisher","DOI":"10.1164\/rccm.201307-1286LE"},{"key":"e_1_2_10_25_1","doi-asserted-by":"publisher","DOI":"10.1055\/s-0042-109775"},{"key":"e_1_2_10_26_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.lungcan.2021.09.015"}],"container-title":["Respirology"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/pdf\/10.1111\/resp.14542","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2023,9,17]],"date-time":"2023-09-17T23:56:09Z","timestamp":1694994969000},"score":1,"resource":{"primary":{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/10.1111\/resp.14542"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2023,8,10]]},"references-count":25,"journal-issue":{"issue":"10","published-print":{"date-parts":[[2023,10]]}},"alternative-id":["10.1111\/resp.14542"],"URL":"https:\/\/doi.org\/10.1111\/resp.14542","archive":["Portico"],"relation":{},"ISSN":["1323-7799","1440-1843"],"issn-type":[{"value":"1323-7799","type":"print"},{"value":"1440-1843","type":"electronic"}],"subject":[],"published":{"date-parts":[[2023,8,10]]},"assertion":[{"value":"2023-03-30","order":0,"name":"received","label":"Received","group":{"name":"publication_history","label":"Publication History"}},{"value":"2023-06-19","order":1,"name":"accepted","label":"Accepted","group":{"name":"publication_history","label":"Publication History"}},{"value":"2023-08-10","order":2,"name":"published","label":"Published","group":{"name":"publication_history","label":"Publication History"}}]}}