Autofluorescence bronchoscopy to identify pre-cancerous bronchial lesions.
BACKGROUND
This study aimed to assess the diagnostic yield of autofluorescence bronchoscopy (AFB) in the detection of pre-cancerous bronchial lesions in a non-selected sample of patients.


METHODS
Both fiberoptic white-light bronchoscopy (WLB) and AFB using the Storz D-light system were performed on 166 consecutive patients. Biopsy specimens were taken in areas of the tracheobronchial tree judged as abnormal or suspicious at WLB and/or AFB. The bronchoscopic procedures were randomly performed by two operators.


RESULTS
A total of 93 patients had a positive biopsy specimen: 80 for cancer and 13 for dysplasia. AFB was abnormal or suspicious in 85 of the 93 patients with a sensitivity of 91.4%. Specificity was 50.7%. In 16 patients with normal WLB examination, AFB identified abnormal or suspicious areas which had a positive biopsy. Thus AFB significantly improved sensitivity of WLB (100% vs 82.8%, respectively, p<0.001) in the entire sample of patients studied. Data was further analysed separately for patients with dysplasia and those with cancer. Indeed, 13 of 16 patients recognized only by AFB had a histological diagnosis of dysplasia. The remaining three patients had a diagnosis of cancer (small intraepithelial neoplastic lesions). Since no other patient with dysplasia was found, AFB had a sensitivity of 100% in diagnosing dysplasia. On the other hand, excluding the 13 patients with dysplasia, WLB had a high sensitivity in diagnosing cancer (93.7%).


CONCLUSIONS
The AFB Storz system showed a high sensitivity. The increase in diagnostic yield of AFB in comparison with WLB was related to the power of AFB to identify pre-cancerous bronchial lesions so showing its usefulness in the early diagnosis of lung cancer.
Fuso
L
L
Respiratory Disease Department, Catholic University, Rome, Italy. leofuso@rm.unicatt.it
Pagliari
G
G
Boniello
V
V
Trove'
A
A
Varone
F
F
Longobardi
A
A
Basso
S
S
Trodella
L
L
D000368:Aged; D001706:Biopsy; D001984:Bronchial Neoplasms / Q000473:pathology*; D001999:Bronchoscopy / Q000379:methods*; D003937:Diagnosis, Differential; D005260:Female; D005336:Fiber Optic Technology; D006801:Humans; D008297:Male; D011230:Precancerous Conditions / Q000473:pathology*; D012680:Sensitivity and Specificity