Fluorescence bronchoscopic surveillance in patients with a history of non-small cell lung cancer.
Background Second lung primaries occur at a rate of 2% per patient per year after curative resection for non-small cell lung carcinoma (NSCLC). The aim of this study was to evaluate the role of fluorescence bronchoscopy using the Xillix((R)) LIFE-Lung Fluorescent Endoscopy System(TM) (LIFE-Lung system) in the surveillance of patients for second NSCLC primaries after resection or curative photodynamic therapy (PDT).Methods NSCLC patients who were disease-free following resection or endobronchial PDT were identified and recruited to participate in a LIFE bronchoscopy surveillance program. All suspicious areas were biopsied; areas of apparent normal mucosa served as negative controls. Biopsy specimens were reviewed by a single pulmonary pathologist.Results Thirty-six patients underwent 53 surveillance LIFE bronchoscopies and 6/112 biopsies revealed intraepithelial neoplasia (IEN) or invasive carcinoma in 6/36 (17%) of patients. The overall relative sensitivity of LIFE versus conventional bronchoscopy was 165% with a negative predictive value of 0.96, for the post-resection subset of patients these values increased to 200% and 0.97, respectively.Conclusions Surveillance LIFE bronchoscopy identified intraepithelial or invasive lesions in 17% of patients previously thought to be disease-free. These data support future multicenter trials on fluorescence bronchoscopic surveillance of NSCLC patients after curative surgical resection or PDT.
Weigel
T L
TL
Department of Surgery Section of Thoracic Surgery University of Pittsburgh Medical Center C800, 200 Lothrop Street Pittsburgh PA 15213 USA.
Kosco
P J
PJ
Dacic
S
S
Yousem
S
S
Luketich
J D
JD