{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,3]],"date-time":"2026-09-03T14:14:20Z","timestamp":1788444860108,"version":"build-2803163510"},"reference-count":44,"publisher":"BMJ","issue":"6","license":[{"start":{"date-parts":[[2026,6,4]],"date-time":"2026-06-04T00:00:00Z","timestamp":1780531200000},"content-version":"unspecified","delay-in-days":3,"URL":"https:\/\/creativecommons.org\/licenses\/by-nc\/4.0\/"}],"funder":[{"name":"Noncommunicable Chronic Diseases-National Science and Technology Major Project","award":["2024ZD0522800"],"award-info":[{"award-number":["2024ZD0522800"]}]},{"name":"Noncommunicable Chronic Diseases-National Science and Technology Major Project","award":["2024ZD0522804"],"award-info":[{"award-number":["2024ZD0522804"]}]},{"name":"Excellence & Innovation Initiative of China-Japan Friendship Hospital","award":["ZRZC2025-XYA01"],"award-info":[{"award-number":["ZRZC2025-XYA01"]}]},{"name":"National High-Level Hospital Clinical Research Funding","award":["2025-NHLHCRF-JBGS-A-WZ-14"],"award-info":[{"award-number":["2025-NHLHCRF-JBGS-A-WZ-14"]}]}],"content-domain":{"domain":["bmj.com"],"crossmark-restriction":true},"short-container-title":["BMJ Open"],"accepted":{"date-parts":[[2026,5,22]]},"published-print":{"date-parts":[[2026,6]]},"abstract":"<jats:sec>\n                    <jats:title>Introduction<\/jats:title>\n                    <jats:p>Semirigid thoracoscopy plays an important role in the diagnosis of pleural diseases. However, its diagnostic performance remains unsatisfactory particularly in terms of the negative likelihood ratio. Therefore, more effective supplementary diagnostic tools are required. Probe-based confocal laser endomicroscopy (pCLE), which allows live tissue imaging at the cellular level, can discriminate between malignant and benign pleura during medical thoracoscopy. However, the clinical relevance of pCLE in pleural disease remains unclear. This protocol describes a randomised controlled trial that evaluates the additional diagnostic value of pCLE in diagnosing pleural diseases using semirigid thoracoscopy.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods and analysis<\/jats:title>\n                    <jats:p>This study is a multicentre, parallel-group, randomised controlled trial that will be conducted at ten sites in China. A total of 158 adult patients with undiagnosed exudative pleural effusions will be enrolled and randomly allocated (1:1) to undergo either a conventional pleural biopsy (control group) or a pCLE-guided pleural biopsy (intervention group) via semirigid thoracoscopy. In the intervention group, a pCLE system will be applied during thoracoscopy to identify suspicious pleural areas for targeted biopsy. The primary outcome is the diagnostic yield of the procedure in patients with unknown causes of pleural effusion. Secondary outcomes include negative likelihood ratio, diagnostic sensitivity in specific diseases, procedural time, rate of adequate specimens for achieving molecular diagnosis and complications.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Ethics and dissemination<\/jats:title>\n                    <jats:p>Ethics approval was obtained from the China-Japan Friendship Hospital Ethics Committee (2025-KY-018). Written informed consent will be obtained from all the participants. The findings will be disseminated through journal publications and conference presentations.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Trial registration number<\/jats:title>\n                    <jats:p>\n                      <jats:ext-link xmlns:xlink=\"http:\/\/www.w3.org\/1999\/xlink\" ext-link-type=\"clintrialgov\" xlink:href=\"NCT06741839\">NCT06741839<\/jats:ext-link>\n                      .\n                    <\/jats:p>\n                  <\/jats:sec>","DOI":"10.1136\/bmjopen-2026-117208","type":"journal-article","created":{"date-parts":[[2026,6,4]],"date-time":"2026-06-04T16:35:32Z","timestamp":1780590932000},"page":"e117208","update-policy":"https:\/\/doi.org\/10.1136\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":0,"title":["Diagnostic yield and safety of probe-based confocal laser endomicroscopy-guided pleural biopsy via semirigid thoracoscope in diagnosing patients with unknown pleural effusion: a protocol for a multicentre, randomised controlled trial (COLLABORATION-I)"],"prefix":"10.1136","volume":"16","clinical-trial-number":[{"clinical-trial-number":"nct06741839","registry":"10.18810\/clinical-trials-gov"}],"author":[{"given":"Ming-Ming","family":"Deng","sequence":"first","affiliation":[{"name":"National Center for Respiratory Medicine; State Key Laboratory of Respiratory Health and Multimorbidity; National Clinical Research Center for Respiratory Diseases; Institute of Respiratory Medicine, Chinese Academy of Medical Sciences; Department of Pulmonary and Critical Care Medicine, Center of Respiratory Medicine, China-Japan Friendship Hospital, Beijing, People's Republic of China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yi","family":"Hu","sequence":"additional","affiliation":[{"name":"Department of Pulmonary and Critical Care Medicine, The Central Hospital of Wuhan, Wuhan, People's Republic of 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