Usefulness of autofluorescence bronchoscopy for detecting bronchial premalignant lesions

Lee, Yeun Seun; Jeuong, Mi Kyong; Lee, Yu Jin; Jang, Pill Soon; Lee, Jeung Eun; Park, Hee Sun; Chung, Chae Uk; Jung, Sung Soo; Kim, Sun Young; Kim, Ju Ock

Abstract

BACKGROUND: Autofluorescence bronchoscopy (AFB), when used as an adjunct to conventional white light bronchoscopy (WLB) improves the bronchoscopist's ability to localized small intraepithelial lesions. Current study was undertaken to evaluate prevalence of preinvasive intraepithelial lesions (dysplasia II-III and CIS) and efficacy of additional AFB system to WLB in comparison with WLB alone.
METHODS
In patients with suspicion of lung cancer or follow-up ones with known lung cancer, WLB (Pentax; BP 3500, Japan) and AFB (Richard Wolf, Germany) were done and all subjects with endoscopic abnormalities underwent biopsies from January 2005 to December 2005.
RESULTS
169 patients (134 suspected to have lung cancer radiologically, 18 with known lung cancer, and 17 with initial abnormal WLB visual findings) were enrolled. Overall preinvasive intraepithelial lesions were detected in 6.5% (11 persons). Biopsy based sensitivity of WLB+AFB and WLB alone for detecting preinvasive intraepithelial lesions was 77.8% compared with 22.2% (relative ratio 3.5, 95% CI 0.93-13.24). Corresponding specificity was 56.9% compared with 89.2% (relative ratio 0.64, 95% CI 0.54-0.75). The positive predicitve value was 6% and 3%, and the negative predictive value was 94% and 87%, respectively, for WLB+AFB and WLB alone.
CONCLUSIONS
WLB+AFB was superior to WLB alone in detecting preinvasive intraepithelial lesions, but general use of AFB as a screening tool seems to be limited in suspected or known lung cancer group because of low prevalence. It is necessary of further study for precise indication for AFB among the lung cancer risk groups.