title: High definition bronchoscopy: a randomized exploratory study of diagnostic value compared to standard white light bronchoscopy and autofluorescence bronchoscopy.
abstract: BACKGROUND
  Videobronchoscopy is an essential diagnostic procedure for evaluation of the central airways and pivotal for the diagnosis and staging of lung cancer. Technological improvements have resulted in high definition (HD) images with advanced real time image enhancement techniques (i-scan).
  
  
  OBJECTIVE
  In this study we aimed to explore the sensitivity of HD+ i-scan bronchoscopy for detection of epithelial changes like vascular abnormalities and suspicious preinvasive lesions, and tumors.
  
  
  METHODS
  In patients scheduled for a therapeutic or diagnostic procedure under general anesthesia videos of the bronchial tree were made using 5 videobronchoscopy modes in random order: normal white light videobronchoscopy (WLB), HD-bronchoscopy (HD), HD bronchoscopy with surface enhancement technique (i-scan1), HD with surface- and tone enhancement technique (i-scan2) and dual mode autofluorescence videobronchoscopy (AFB). The videos were scored in random order by two independent and blinded expert bronchoscopists.
  
  
  RESULTS
  In 29 patients all videos were available for analysis. Vascular abnormalities were scored most frequently in HD + i-scan2 bronchoscopy (1.33 ± 0.29 abnormal or suspicious sites per patient) as compared to 0.12 ± 0.05 site for AFB (P = 0.003). Sites suspicious for preinvasive lesions were most frequently reported using AFB (0.74 ± 0.12 sites per patient) as compared to 0.17 ± 0.06 for both WLB and HD bronchoscopy (P = 0.003). Tumors were detected equally by all modalities. The preferred modality was HD bronchoscopy with i-scan (tone- plus surface and surface enhancement in respectively 38% and 35% of cases P = 0.006).
  
  
  CONCLUSIONS
  This study shows that high definition bronchoscopy with image enhancement technique may result in better detection of subtle vascular abnormalities in the airways. Since these abnormalities may be related to preneoplastic lesions and tumors this is of clinical relevance. Further investigations using this technique relating imaging to histology are warranted.
authors.forename: Erik H F M
authors.initials: EH
authors.lastname: van der Heijden
authors.forename: Wouter
authors.initials: W
authors.lastname: Hoefsloot
authors.forename: Hieronymus W H
authors.initials: HW
authors.lastname: van Hees
authors.forename: Olga C J
authors.initials: OC
authors.lastname: Schuurbiers
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D001980:Bronchi / Q000473:pathology; D001999:Bronchoscopy / Q000379:methods; D004847:Epithelial Cells / Q000473:pathology; D007090:Image Interpretation, Computer-Assisted; D008027:Light; D008175:Lung Neoplasms / Q000473:pathology / Q000556:secondary; D015588:Observer Variation; D061848:Optical Imaging / Q000379:methods; D011230:Precancerous Conditions / Q000473:pathology; D011237:Predictive Value of Tests; D011446:Prospective Studies; D015203:Reproducibility of Results; D014741:Video Recording
references.citation: World J Gastroenterol. 2010 Mar 7;16(9):1043-9
references.pmid: 20205272
references.citation: J Thorac Oncol. 2011 Aug;6(8):1336-44
references.pmid: 21642863
references.citation: Ann Thorac Med. 2013 Apr;8(2):93-8
references.pmid: 23741271
references.citation: Thorax. 2003 Nov;58(11):989-95
references.pmid: 14586056
references.citation: Lung Cancer. 2010 Aug;69(2):194-202
references.pmid: 20541831
references.citation: Chest. 2013 May;143(5 Suppl):e263S-77S
references.pmid: 23649442
references.citation: Thorax. 2005 Jun;60(6):496-503
references.pmid: 15923251
references.citation: Lung Cancer. 2011 Aug;73(2):183-8
references.pmid: 21237526
references.citation: Lung Cancer. 2007 Oct;58(1):44-9
references.pmid: 17532537
references.citation: Lung Cancer. 2006 Apr;52(1):21-7
references.pmid: 16497411
references.citation: J Thorac Oncol. 2009 Sep;4(9):1060-5
references.pmid: 19704335
references.citation: Interact Cardiovasc Thorac Surg. 2010 Dec;11(6):740-4
references.pmid: 20852332
references.citation: Thorax. 2002 Oct;57(10):902-7
references.pmid: 12324679
references.citation: Med Oncol. 2013 Mar;30(1):374
references.pmid: 23275117