title: Color fluorescence ratio for detection of bronchial dysplasia and carcinoma in situ.
abstract: BACKGROUND
  Autofluorescence bronchoscopy is more sensitive than conventional bronchoscopy for detecting early airway mucosal lesions. Decreased specificity can lead to excessive biopsy and increased procedural time. Onco-LIFE, a device that combines fluorescence and reflectance imaging, allows numeric representation by expressing red-to-green ratio (R/G ratio) within the region of interest. The aim of the study was to determine if color fluorescence ratio (R/G ratio) added to autofluorescence bronchoscopy could provide an objective means to guide biopsy.
  
  
  METHODS
  Subjects at risk for lung cancer were recruited at two centers: VU University Medical Centre (Amsterdam) and BC Cancer Agency (Canada). R/G ratio for each site appearing normal or abnormal was measured before biopsy. R/G ratios were correlated with pathology, and a receiver operating characteristic curve of R/G ratio for high-grade and moderate dysplasia was done. Following analysis of the training data set obtained from two centers, a prospective validation study was done.
  
  
  RESULTS
  Three thousand three hundred sixty-two adequate biopsies from 738 subjects with their corresponding R/G ratios were analyzed. R/G ratio 0.54 conferred 85% sensitivity and 80% specificity for the detection of high-grade and moderate dysplasia, area under the curve was 0.90, and 95% confidence interval was 0.88 to 0.92. In another 70 different sites that were assessed, kappa measurements of agreement of R/G ratios with visual scores and pathology were 0.66 (P < 0.0001) and 0.61 (P < 0.0001), respectively. R/G ratio combined with visual score improved specificity to 88% (95% confidence interval, 0.73-0.96) for high-grade and moderate dysplasia.
  
  
  CONCLUSIONS
  Color fluorescence ratio can objectively guide the bronchoscopist in selecting sites for biopsy with good pathologic correlation.
authors: Pulmonary Diseases and Pathology, VU University Medical Centre, Amsterdam, The Netherlands. lee.pyng@sgh.com.sg
authors: Pyng
authors: P
authors: Lee
authors: Remco M
authors: RM
authors: van den Berg
authors: Stephen
authors: S
authors: Lam
authors: Adi F
authors: AF
authors: Gazdar
authors: Katrien
authors: K
authors: Grunberg
authors: Annette
authors: A
authors: McWilliams
authors: Jean
authors: J
authors: Leriche
authors: Pieter E
authors: PE
authors: Postmus
authors: Tom G
authors: TG
authors: Sutedja
mesh_terms: D000368:Aged; D001706:Biopsy; D001980:Bronchi / Q000473:pathology; D001982:Bronchial Diseases / Q000175:diagnosis* / Q000473:pathology; D001984:Bronchial Neoplasms / Q000175:diagnosis* / Q000473:pathology; D001999:Bronchoscopy / Q000379:methods*; D002278:Carcinoma in Situ / Q000175:diagnosis* / Q000473:pathology; D003937:Diagnosis, Differential; D005260:Female; D005453:Fluorescence; D006801:Humans; D008297:Male; D008875:Middle Aged; D015203:Reproducibility of Results; D012680:Sensitivity and Specificity