title: White light, autofluorescence and narrow-band imaging bronchoscopy for diagnosing airway pre-cancerous and early cancer lesions: a systematic review and meta-analysis.
abstract: BACKGROUND
  We aimed to summarize the diagnostic accuracy of white light bronchoscopy (WLB) and advanced techniques for airway pre-cancerous lesions and early cancer, such as autofluorescence bronchoscopy (AFB), AFB combined with WLB (AFB + WLB) and narrow-band imaging (NBI) bronchoscopy.
  
  
  METHODS
  We searched for eligible studies in seven electronic databases from their date of inception to Mar 20, 2015. In eligible studies, detected lesions should be confirmed by histopathology. We extracted and calculated the 2×2 data based on the pathological criteria of lung tumor, including high-grade lesions from moderate dysplasia (MOD) to invasive carcinoma (INV). Random-effect model was used to pool sensitivity, specificity, diagnostic odds ratio (DOR) and the area under the receiver-operating characteristic curve (AUC).
  
  
  RESULTS
  In 53 eligible studies (39 WLB, 39 AFB, 17 AFB + WLB, 6 NBI), diagnostic performance for high-grade lesions was analyzed based on twelve studies (10 WLB, 7 AFB, 7 AFB + WLB, 1 NBI), involving with totally 2,880 patients and 8,830 biopsy specimens. The sensitivity, specificity, DOR and AUC of WLB were 51% (95% CI, 34-68%), 86% (95% CI, 73-84%), 6 (95% CI, 3-13) and 77% (95% CI, 73-81%). Those of AFB and AFB + WLB were 93% (95% CI, 77-98%) and 86% (95% CI, 75-97%), 52% (95% CI, 37-67%) and 71% (95% CI, 56-87%), 15 (95% CI, 4-57) and 16 (95% CI, 6-41), and 76% (95% CI, 72-79%) and 82% (95% CI, 78-85%), respectively. NBI presented 100% sensitivity and 43% specificity.
  
  
  CONCLUSIONS
  With higher sensitivity, advanced bronchoscopy could be valuable to avoid missed diagnosis. Combining strategy of AFB and WLB may contribute preferable diagnosis rather than their alone use for high-grade lesions. Studies of NBI warrants further investigation for precancerous lesions.
authors.affiliation: Department of Thoracic Surgery and Oncology, the First Affiliated Hospital of Guangzhou Medical University, Guangzhou 510120, China;; China State Key Laboratory of Respiratory Disease, Guangzhou Institute of Respiratory Disease, Guangzhou 510120, China;; National Clinical Research Centre of Respiratory Disease, Guangzhou 510120, China;; Graduate School, Guangzhou Medical University, Guangzhou 510120, China.
authors.forename: Jianrong
authors.initials: J
authors.lastname: Zhang
authors.affiliation: Graduate School, Guangzhou Medical University, Guangzhou 510120, China;; Department of Pathology, the First Affiliated Hospital of Guangzhou Medical University, Guangzhou 510120, China.
authors.forename: Jieyu
authors.initials: J
authors.lastname: Wu
authors.affiliation: Department of Clinical Laboratory, Guangdong Academy of Medical Sciences and General Hospital, Guangzhou 510120, China.
authors.forename: Yujing
authors.initials: Y
authors.lastname: Yang
authors.affiliation: Department of Respiratory Medicine, the Fifth Affiliated Hospital of Southern Medical University, Guangzhou 510120, China.
authors.forename: Hua
authors.initials: H
authors.lastname: Liao
authors.affiliation: China State Key Laboratory of Respiratory Disease, Guangzhou Institute of Respiratory Disease, Guangzhou 510120, China;; National Clinical Research Centre of Respiratory Disease, Guangzhou 510120, China;; Graduate School, Guangzhou Medical University, Guangzhou 510120, China;; Department of Critical Care Medicine, the First Affiliated Hospital of Guangzhou Medical University, Guangzhou 510120, China.
authors.forename: Zhiheng
authors.initials: Z
authors.lastname: Xu
authors.affiliation: Institute of International Education, Guangdong University of Foreign Studies, Guangzhou 510120, China.
authors.forename: Lindsey Tristine
authors.initials: LT
authors.lastname: Hamblin
authors.affiliation: Department of Thoracic Surgery and Oncology, the First Affiliated Hospital of Guangzhou Medical University, Guangzhou 510120, China;; China State Key Laboratory of Respiratory Disease, Guangzhou Institute of Respiratory Disease, Guangzhou 510120, China;; National Clinical Research Centre of Respiratory Disease, Guangzhou 510120, China;; Graduate School, Guangzhou Medical University, Guangzhou 510120, China.
authors.forename: Long
authors.initials: L
authors.lastname: Jiang
authors.affiliation: Department of Thoracic Surgery, University Hospitals Leuven, Leuven, Belgium.
authors.forename: Lieven
authors.initials: L
authors.lastname: Depypere
authors.affiliation: Department of Thoracic Surgery, Glenfield Hospital, Leicester, LE3 9QP, UK.
authors.forename: Keng Leong
authors.initials: KL
authors.lastname: Ang
authors.affiliation: Department of Thoracic Surgery and Oncology, the First Affiliated Hospital of Guangzhou Medical University, Guangzhou 510120, China;; China State Key Laboratory of Respiratory Disease, Guangzhou Institute of Respiratory Disease, Guangzhou 510120, China;; National Clinical Research Centre of Respiratory Disease, Guangzhou 510120, China;; Graduate School, Guangzhou Medical University, Guangzhou 510120, China.
authors.forename: Jiaxi
authors.initials: J
authors.lastname: He
authors.affiliation: Department of Neonatology, the Third Affiliated Hospital of Guangzhou Medical University, Guangzhou 510120, China.
authors.forename: Ziyan
authors.initials: Z
authors.lastname: Liang
authors.affiliation: Medical Equipment Section, the Third Affiliated Hospital of Sun Yat-sen University, Guangzhou 510120, China.
authors.forename: Jun
authors.initials: J
authors.lastname: Huang
authors.affiliation: Department of Thoracic Surgery and Oncology, the First Affiliated Hospital of Guangzhou Medical University, Guangzhou 510120, China;; China State Key Laboratory of Respiratory Disease, Guangzhou Institute of Respiratory Disease, Guangzhou 510120, China;; National Clinical Research Centre of Respiratory Disease, Guangzhou 510120, China.
authors.forename: Jingpei
authors.initials: J
authors.lastname: Li
authors.affiliation: Department of Thoracic Surgery and Oncology, the First Affiliated Hospital of Guangzhou Medical University, Guangzhou 510120, China;; China State Key Laboratory of Respiratory Disease, Guangzhou Institute of Respiratory Disease, Guangzhou 510120, China;; National Clinical Research Centre of Respiratory Disease, Guangzhou 510120, China;; Graduate School, Guangzhou Medical University, Guangzhou 510120, China.
authors.forename: Qihua
authors.initials: Q
authors.lastname: He
authors.affiliation: Department of Thoracic Surgery and Oncology, the First Affiliated Hospital of Guangzhou Medical University, Guangzhou 510120, China;; China State Key Laboratory of Respiratory Disease, Guangzhou Institute of Respiratory Disease, Guangzhou 510120, China;; National Clinical Research Centre of Respiratory Disease, Guangzhou 510120, China.
authors.forename: Wenhua
authors.initials: W
authors.lastname: Liang
authors.affiliation: Department of Thoracic Surgery and Oncology, the First Affiliated Hospital of Guangzhou Medical University, Guangzhou 510120, China;; China State Key Laboratory of Respiratory Disease, Guangzhou Institute of Respiratory Disease, Guangzhou 510120, China;; National Clinical Research Centre of Respiratory Disease, Guangzhou 510120, China.
authors.forename: Jianxing
authors.initials: J
authors.lastname: He
keywords: Advanced bronchoscopy; autofluorescence bronchoscopy (AFB); lung cancer; narrow-band imaging bronchoscopy; white light bronchoscopy (WLB)