title: Low Prevalence of High-Grade Lesions Detected With Autofluorescence Bronchoscopy in the Setting of Lung Cancer Screening in the Pan-Canadian Lung Cancer Screening Study.
abstract: BACKGROUND
  Lung cancer screening with low-dose CT (LDCT) scan has been demonstrated to reduce lung cancer mortality. Preliminary reports suggested that up to 20% of lung cancers may be CT scan occult but detectable by autofluorescence bronchoscopy (AFB). We evaluated the prevalence of CT scan occult, invasive, and high-grade preinvasive lesions in high-risk participants undergoing screening for lung cancer.
  
  
  METHODS
  The first 1,300 participants from seven centers in the Pan-Canadian Early Detection of Lung Cancer Study who had ≥ 2% lung cancer risk over 5 years were invited to have an AFB in addition to a LDCT scan. We determined the prevalence of CT scan and AFB abnormalities and analyzed the association between selected predictor variables and preinvasive lesions plus invasive cancer.
  
  
  RESULTS
  A total of 776 endobronchial biopsies were performed in 333 of 1,300 (25.6%) participants. Dysplastic or higher-grade lesions were detected in 5.3% of the participants (n = 68; mild dysplasia: n = 36, moderate dysplasia: n = 25, severe dysplasia: n = 3, carcinoma in situ [CIS]: n = 1, and carcinoma: n = 4). Only one typical carcinoid tumor and one CIS lesion were detected by AFB alone, for a rate of CT scan occult cancer of 0.15% (95% CI, 0.0%-0.6%). Fifty-six prevalence lung cancers were detected by LDCT scan (4.3%). The only independent risk factors for finding of dysplasia or CIS on AFB were smoking duration (OR, 1.05; 95% CI, 1.02-1.07) and FEV1percent predicted (OR, 0.99; 95% CI, 0.98-0.99).
  
  
  CONCLUSIONS
  The addition of AFB to LDCT scan in a high lung cancer risk cohort detected too few CT occult cancers (0.15%) to justify its incorporation into a lung cancer screening program.
  
  
  BACKGROUND
  ClinicalTrials.gov; No.: NCT00751660; URL: www.clinicaltrials.gov.
authors.affiliation: Division of Respiratory Medicine, University of Calgary, Calgary, AB, Canada. Electronic address: alain.tremblay@ucalgary.ca.
authors.forename: Alain
authors.initials: A
authors.lastname: Tremblay
authors.affiliation: Division of Respiratory Medicine, University of Calgary, Calgary, AB, Canada.
authors.forename: Niloofar
authors.initials: N
authors.lastname: Taghizadeh
authors.affiliation: Fionna Stanley Hospital, Perth, WA, Australia.
authors.forename: Annette M
authors.initials: AM
authors.lastname: McWilliams
authors.affiliation: Division of Respiratory Medicine, University of Calgary, Calgary, AB, Canada.
authors.forename: Paul
authors.initials: P
authors.lastname: MacEachern
authors.affiliation: Division of Respiratory Medicine, University of Calgary, Calgary, AB, Canada.
authors.forename: David R
authors.initials: DR
authors.lastname: Stather
authors.affiliation: Princess Margaret Cancer Centre and University Health Network, Toronto, ON, Canada.
authors.forename: Kam
authors.initials: K
authors.lastname: Soghrati
authors.affiliation: Juravinski Cancer Centre and McMaster University, Hamilton, ON, Canada.
authors.forename: Serge
authors.initials: S
authors.lastname: Puksa
authors.affiliation: Juravinski Cancer Centre and McMaster University, Hamilton, ON, Canada.
authors.forename: John R
authors.initials: JR
authors.lastname: Goffin
authors.affiliation: Princess Margaret Cancer Centre and University Health Network, Toronto, ON, Canada.
authors.forename: Kazuhiro
authors.initials: K
authors.lastname: Yasufuku
authors.affiliation: Ottawa Hospital, Ottawa, ON, Canada.
authors.forename: Kayvan
authors.initials: K
authors.lastname: Amjadi
authors.affiliation: Ottawa Hospital, Ottawa, ON, Canada.
authors.forename: Garth
authors.initials: G
authors.lastname: Nicholas
authors.affiliation: Institut Universitaire de Cardiologie et de Pneumologie de Québec, Québec, QC, Canada.
authors.forename: Simon
authors.initials: S
authors.lastname: Martel
authors.affiliation: Institut Universitaire de Cardiologie et de Pneumologie de Québec, Québec, QC, Canada.
authors.forename: Francis
authors.initials: F
authors.lastname: Laberge
authors.affiliation: Beatrice Hunter Cancer Research Institute and Dalhousie University, Halifax, NS, Canada.
authors.forename: Michael
authors.initials: M
authors.lastname: Johnston
authors.affiliation: Princess Margaret Cancer Centre and University Health Network, Toronto, ON, Canada.
authors.forename: Frances A
authors.initials: FA
authors.lastname: Shepherd
authors.affiliation: British Columbia Cancer Agency, Vancouver, BC, Canada.
authors.forename: Diana N
authors.initials: DN
authors.lastname: Ionescu
authors.affiliation: University of Calgary & Foothills Medical Centre, Calgary, AB, Canada.
authors.forename: Stefan
authors.initials: S
authors.lastname: Urbanski
authors.affiliation: Princess Margaret Cancer Centre and University Health Network, Toronto, ON, Canada.
authors.forename: David
authors.initials: D
authors.lastname: Hwang
authors.affiliation: McMaster University and St Joseph's Healthcare, Hamilton, ON, Canada.
authors.forename: Jean-Claude
authors.initials: JC
authors.lastname: Cutz
authors.affiliation: Ottawa Hospital, Ottawa, ON, Canada.
authors.forename: Harmanjatinder S
authors.initials: HS
authors.lastname: Sekhon
authors.affiliation: Institut Universitaire de Cardiologie et de Pneumologie de Québec, Québec, QC, Canada.
authors.forename: Christian
authors.initials: C
authors.lastname: Couture
authors.affiliation: Queen Elizabeth II Health Sciences Centre, Halifax, NS, Canada.
authors.forename: Zhaolin
authors.initials: Z
authors.lastname: Xu
authors.affiliation: Department of Respiratory Medicine, Erasmus Medical Center, Rotterdam, The Netherlands.
authors.forename: Tom G
authors.initials: TG
authors.lastname: Sutedja
authors.affiliation: British Columbia Cancer Agency, Vancouver, BC, Canada.
authors.forename: Sukhinder
authors.initials: S
authors.lastname: Atkar-Khattra
authors.affiliation: Brock University, St. Catharines, ON, Canada.
authors.forename: Martin C
authors.initials: MC
authors.lastname: Tammemagi
authors.affiliation: Princess Margaret Cancer Centre and University Health Network, Toronto, ON, Canada.
authors.forename: Ming-Sound
authors.initials: MS
authors.lastname: Tsao
authors.affiliation: British Columbia Cancer Agency, Vancouver, BC, Canada.
authors.forename: Stephen C
authors.initials: SC
authors.lastname: Lam
mesh_terms: D000368:Aged; D001706:Biopsy; D001999:Bronchoscopy / Q000379:methods*; D002170:Canada / Q000453:epidemiology; D055088:Early Detection of Cancer; D005260:Female; D006801:Humans; D008175:Lung Neoplasms / Q000453:epidemiology* / Q000473:pathology*; D008297:Male; D008403:Mass Screening; D008875:Middle Aged; D060787:Neoplasm Grading; D009361:Neoplasm Invasiveness; D011230:Precancerous Conditions / Q000453:epidemiology* / Q000473:pathology; D015995:Prevalence; D012307:Risk Factors
keywords: bronchoscopy; dysplasia; lung cancer; screening