Wijmans Lizzy, Univ Amsterdam, Dept Resp Med, Med Ctr, Amsterdam, Netherlands.

•We assessed the feasibility and safety of using nCLE for real-time identification of lung cancer.

•In patients with suspected or proven lung cancer scheduled for endoscopic ultrasound (EUS), lung tumors and mediastinal lymph nodes were imaged with nCLE before fine needle aspiration (FNA) was performed.
•nCLE lung cancer characteristics were identified by comparison with pathology. Multiple blinded raters validated CLE videos of lung tumors and mediastinal nodes twice.

•EUS-nCLE-FNA was performed in 22 patients with suspected or proven lung cancer in whom 27 lesions (6 tumors, 21 mediastinal nodes) were evaluated without complications.
•Three nCLE-lung cancer criteria (enlarged pleomorphic cells, dark clumps, directional streaming) were identified.
•Accuracy of nCLE imaging for detecting malignancy in tumors and metastatic lymph nodes was 90% and 89% respectively. Both interobserver (mean IOA (k=0.68 (95% CI:0.66 - 0.70)) and intra-observer agreement (mean IOR (k=0.70 ± 0.15)), were substantial.

•Real-time lung cancer detection by endosonography-guided nCLE was feasible and safe. Lung cancer characteristics were accurately recognized.