Clinical Utility of Needle-Based Confocal Laser Endomicroscopy for Peripheral Pulmonary Lesions

This prospective, multicenter diagnostic accuracy study will evaluate the clinical utility of needle-based confocal laser endomicroscopy (nCLE) for differentiating malignant from benign peripheral pulmonary lesions (PPLs). A total of 100 participants undergoing bronchoscopic evaluation of PPLs will be enrolled at three hospitals in China. Following successful lesion localization using radial endobronchial ultrasound, nCLE imaging will be performed after intravenous administration of fluorescein, followed by standard bronchoscopic tissue sampling. nCLE findings will be compared with the final diagnosis established by histopathology, surgical pathology, or six-month clinical and imaging follow-up when necessary. The primary outcomes are the sensitivity, specificity, positive predictive value, negative predictive value, and overall diagnostic accuracy of nCLE. Procedure duration and procedure-related adverse events will also be recorded. The investigators hypothesize that nCLE can accurately distinguish malignant from benign PPLs in real time.

Inclusion Criteria: * (1) Age 18 years or older. (2) A peripheral pulmonary lesion identified on chest CT. (3) Bronchoscopic biopsy considered clinically necessary by the treating physician to establish a pathologic diagnosis. (4) Willingness to undergo r-EBUS and nCLE examinations. (5) Voluntary participation with written informed consent. Exclusion Criteria: * (1) A contraindication to bronchoscopy, including severe cardiopulmonary disease, coagulation disorder, failure to discontinue anticoagulant therapy or anticoagulant medication for at least 5 days before the procedure, poor tolerance of anesthesia, psychiatric illness, or severe neurosis. (2) Pregnancy or breastfeeding. (3) Known allergy to fluorescein sodium. (4) Coagulation disorder. (5) A known allergic disorder, history of asthma, hepatic failure, renal failure, or another contraindication to fluorescein sodium injection. (6) Continued use of a systemic beta-blocker on the day of the procedure, or inability to discontinue the beta-blocker safely as assessed by the investigator and anesthesiologist. (7) Inability to cooperate with the study for any reason, or any other condition that the investigator considers unsuitable for enrollment.