Background and aims: Current modalities for lymph node staging in cancer can be limited. We sought to
evaluate the feasibility of needle-based confocal laser endomicroscopy (nCLE) at the
time of endoscopic ultrasound (EUS) and to describe the nCLE features that distinguish
between benign, malignant, and inflammatory lymph nodes.
Methods: We collected data on 28 consecutive patients during EUS staging of malignancy or assessment
of enlarged lymph nodes. Patients underwent nCLE at the time of EUS followed by fine
needle biopsy. nCLE images were correlated with the patients’ final histopathology.
Results: All 28 patients successfully underwent nCLE during EUS without adverse events. There
were 17 cases of carcinoma, 4 lymphoid malignancies, and 7 benign lymph nodes. We
characterized the various nCLE features of the lymph node capsule and cortex. Features
of carcinoma, such as clusters of dark pleomorphic tumor cells, were identified and
found to correlate well with the final pathology. Lymphoid malignancies often had
enlarged follicles, but this was inconsistent.
Conclusions: nCLE of lymph nodes at the time of EUS is feasible and appears to be safe. Dark pleomorphic
cells were readily identified in all of the malignant lymph nodes and correlated with
tumor cells seen on histology.
