Bronchial intraepithelial neoplasia/early central airways lung cancer: ACCP evidence-based clinical practice guidelines (2nd edition).
BACKGROUND
An evidence-based approach is necessary for the localization and management of intraepithelial and microinvasive non-small cell lung cancer in the central airways.


METHODS
Material appropriate to this topic was obtained by literature search of a computerized database. Recommendations were developed by the writing committee and then reviewed by the entire guidelines panel. The final recommendations were made by the Chair and were voted on by the entire committee.


RESULTS
White light bronchoscopy has diagnostic limitations in the detection of microinvasive lesions. Autofluorescence bronchoscopy (AFB) is a technique that has been shown to be a sensitive method for detecting these lesions. In patients with moderate dysplasia or worse on sputum cytology and normal chest radiographic findings, bronchoscopy should be performed. If moderate/severe dysplasia or carcinoma in situ (CIS) is detected in the central airways, then bronchoscopic surveillance is recommended. The use of AFB is preferred if available. In a patient being considered for curative endobronchial therapy to treat microinvasive lesions, AFB is useful. A number of endobronchial techniques as therapeutic options are available for the management of CIS and can be recommended to patients with inoperable disease. In patients with operable disease, surgery remains the mainstay of treatment, although patients may be counseled about these techniques.


CONCLUSIONS
AFB is a useful tool for the localization of microinvasive neoplasia. A number of endobronchial techniques available for the curative treatment can be considered first-line therapy in inoperable cases. For operable cases, the techniques may be considered and discussed with the patients.
Kennedy
Timothy C
TC
MBBS, 550 W University Blvd, Suite 4903, Indianapolis IN 46202, USA. pmathur@IUPUI.edu
McWilliams
Annette
A
Edell
Eric
E
Sutedja
Tom
T
Downie
Gordon
G
Yung
Rex
R
Gazdar
Adi
A
Mathur
Praveen N
PN
D001984:Bronchial Neoplasms / Q000175:diagnosis* / Q000601:surgery; D001999:Bronchoscopy / Q000379:methods; D002278:Carcinoma in Situ / Q000175:diagnosis* / Q000601:surgery; D002289:Carcinoma, Non-Small-Cell Lung / Q000175:diagnosis* / Q000601:surgery; D002986:Clinical Trials as Topic; D019317:Evidence-Based Medicine; D006801:Humans; D008175:Lung Neoplasms / Q000175:diagnosis* / Q000601:surgery; D013902:Radiography, Thoracic; D012680:Sensitivity and Specificity; D012720:Severity of Illness Index; D013183:Sputum / Q000166:cytology