针刺式共聚焦激光内镜技术（nCLE）可实现针尖处的实时显微成像。在支气管镜肺结节分析期间，利用nCLE恶性标准来辅助诊断病变。然而，至今尚缺乏nCLE用于肉芽肿的诊断标准。本研究的目的是确定和验证nCLE肉芽肿的诊断标准，并评估盲评员是否能将恶性和肉芽肿的nCLE录像区分开来。在疑似结节病患者中，通过内窥镜超声程序进行nCLE成像，并随后进行针吸。通过与病理学和最终诊断结果进行比较，确定了nCLE肉芽肿的诊断标准。此外，将前瞻性试验和临床护理中的肉芽肿性肺结节的nCLE录像与提出的nCLE肉芽肿诊断标准进行比较。盲评员两次验证了结节病和反应性骨髓淋巴结的nCLE录像以及恶性肉芽肿和肉芽肿性肺结节的nCLE录像。通过nCLE成像，在14名结节病患者中确定了肉芽肿的诊断标准（明亮、均匀且有清晰边界的病变）。评估了26个在淋巴结中获取的nCLE录像（结节病：n=15；反应性骨髓淋巴结：n=11；总计260次评估）。诊断标准的准确性为88%。评价者间的一致性（κ = 0.63，95% CI 0.54-0.72）和评价者内的一致性（κ = 0.70 ± 0.06）达到程度上的认可。根据在肺结节中获得的12个nCLE录像（肉芽肿：n=4；恶性：n=6；恶性+肉芽肿：n=2；总计120次评估）确定了肉芽肿和恶性的诊断标准，其准确性分别为92%和75%。nCLE成像有助于实时观察肉芽肿。盲评员能够准确且一致地在nCLE成像中识别出肉芽肿，并将其与恶性诊断标准区分开。我们的数据显示了nCLE作为实时支气管镜引导工具在肺结节分析中的潜力。© 2023 The Authors. Respirology 由澳大利亚约翰威利和亚太呼吸系统学会代表亚太呼吸系统学会出版。

Needle-based confocal laser endomicroscopy (nCLE) allows real-time microscopic imaging at the needle tip. nCLE malignancy criteria are used for tool-in-lesion 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.In patients with suspected sarcoidosis, nCLE-imaging 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-videos 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.Granuloma criteria were identified (brighter-toned, homogeneous and well-demarcated lesions) based on nCLE-imaging in 14 sarcoidosis patients. Raters evaluated 26 nCLE-videos obtained in lymph nodes (n = 15 sarcoidosis; n = 11 reactive and total of 260 ratings). Granuloma criteria were recognized with 88% accuracy. The inter-observer (κ = 0.63, 95% CI 0.54-0.72) and intra-observer reliability (κ = 0.70 ± 0.06) were substantial. Based on 12 nCLE-videos obtained in lung nodules (n = 4 granulomas, n = 6 malignancy, n = 2 malignancy + granulomas and total of 120 ratings) granuloma and malignancy criteria were recognized with 92% and 75% accuracy.nCLE imaging facilitates real-time granuloma visualization. Blinded raters accurately and consistently recognized granulomas on nCLE-imaging and distinguished nCLE granuloma criteria from malignancy. Our data show the potential of nCLE as a real-time bronchoscopic guidance tool for lung nodule analysis.© 2023 The Authors. Respirology published by John Wiley & Sons Australia, Ltd on behalf of Asian Pacific Society of Respirology.