title: Narrow-band imaging bronchoscopy in the detection of premalignant airway lesions: a meta-analysis of diagnostic test accuracy.
abstract: OBJECTIVE
  Both autofluorescence imaging bronchoscopy and narrow-band imaging have shown promise in the detection of premalignant airway lesions, each by utilizing different bandwidths of lights for better characterization of the mucosal and submucosal vascular grid. Since previously published meta-analyses have shown poor specificity of autofluorescence imaging bronchoscopy, we specifically studied the diagnostic accuracy of narrow-band imaging alone and in combination with autofluorescence imaging bronchoscopy in the detection of premalignant airway lesions.
  
  
  METHODS
  After an extensive search of eligible studies from PubMed and Medline, extracted data were pooled with weighted averages. Symmetrical summary-receiver operating characteristic curves were constructed to summarize the results quantitatively. Study heterogeneity was assessed by the I(2) index.
  
  
  RESULTS
  Analysis of data from eight studies on narrow-band imaging showed a pooled sensitivity of 0.80 [95% confidence interval (CI): 0.77-0.83] and a pooled specificity of 0.84 (95% CI: 0.81-0.86). Summary-receiver operating characteristic curves from the data on narrow-band imaging calculated an area-under-the-curve of 0.908 (standard error 0.01). The diagnostic odds ratio of narrow-band imaging was 31.49 (95% CI: 12.17-81.45). Data from studies where narrow-band imaging and autofluorescence imaging bronchoscopy were used together showed a pooled sensitivity, specificity, area-under-the-curve and diagnostic odds ratios of 0.86 (95% CI: 0.82-0.89), 0.75 (95% CI: 0.71-0.79), 0.964 (standard error 0.05) and 27.96 (95% CI: 3.04-257.21), respectively.
  
  
  CONCLUSIONS
  Our findings indicate that in the evaluation of premalignant airway lesions, narrow-band imaging has a higher sensitivity, specificity and diagnostic odds ratios compared with autofluorescence imaging bronchoscopy. However, combining autofluorescence imaging bronchoscopy and narrow-band imaging does not significantly improve test performance characteristics.
authors.affiliation: Department of Medicine, Division of Pulmonary, Critical Care and Sleep Medicine, The Ohio State University, Columbus, Ohio, USA Iftikhar.5@osu.edu.
authors.forename: Imran H
authors.initials: IH
authors.lastname: Iftikhar
authors.affiliation: Department of Medicine, Division of Pulmonary, Critical Care and Sleep Medicine, National Jewish Health, Denver, Colorado, USA.
authors.forename: Ali I
authors.initials: AI
authors.lastname: Musani
mesh_terms: D001999:Bronchoscopy / Q000379:methods*; D006801:Humans; D008175:Lung Neoplasms / Q000175:diagnosis* / Q000473:pathology; D062048:Narrow Band Imaging; D061848:Optical Imaging / Q000379:methods; D011230:Precancerous Conditions / Q000175:diagnosis* / Q000473:pathology; D012680:Sensitivity and Specificity
keywords: autofluorescence imaging bronchoscopy; meta-analysis; narrow-band imaging bronchoscopy