Autofluorescence improves pretreatment mucosal assessment in head and neck cancer patients.
OBJECTIVE
Panendoscopy is used in selected patients with head and neck cancer to detect second primary disease. We hypothesized that adding autofluorescence to the bronchoscopy and laryngoscopy part of this procedure could add to the detection of clinically meaningful dysplasias and carcinomas in both the head and neck and bronchus, with resultant change in management.


METHODS
Prospective observational study on consecutive patients with head and neck cancer who had panendoscopy prior to surgery.


METHODS
Teaching hospital, tertiary referral center.


METHODS
All patients had white-light inspection observed by ENT surgeons, followed by autofluorescence inspection of the head and neck tumor and surrounding area as well as the bronchus. Extra biopsies were taken from regions of abnormal fluorescence where there was no white-light abnormality.


RESULTS
Sixty-six patients were studied; mean age 64.9 +/- 11 years. As a result of autofluorescence, 33 mucosal biopsies were taken from the head and neck and 37 from the bronchus. Histology included three carcinoma in situ lesions and four severe dysplasias. As a result of these autofluorescence biopsies, change of management occurred in four patients (6% of the total patients). Standard panendoscopy changed management in five patients. Therefore, standard panendoscopy led to change in management in only 55 percent of cases (CI 21%-86%, P = 0.02), with the rest detected by autofluorescence.


CONCLUSIONS
Adding autofluorescence to panendoscopy in patients with head and neck cancer changed management in a clinically significant number of patients.
Fielding
David
D
Department of Thoracic Medicine, Royal Brisbane and Women's Hospital, Herston, Brisbane, Queensland, Australia. david_fielding@health.qld.gov.au
Agnew
Julienne
J
Wright
David
D
Hodge
Robert
R
D000368:Aged; D001984:Bronchial Neoplasms / Q000473:pathology* / Q000628:therapy; D001999:Bronchoscopy; D002277:Carcinoma / Q000473:pathology* / Q000628:therapy; D015331:Cohort Studies; D005260:Female; D005453:Fluorescence; D006258:Head and Neck Neoplasms / Q000473:pathology* / Q000628:therapy; D006801:Humans; D007828:Laryngoscopy; D008297:Male; D008875:Middle Aged; D009092:Mucous Membrane / Q000473:pathology; D009361:Neoplasm Invasiveness; D011237:Predictive Value of Tests