Autofluorescence Bronchoscopy Improves Staging of Radiographically Occult Lung Cancer and Has an Impact on Therapeutic Strategy

Sutedja, Tom G.; Codrington, Henk; Risse, Elle K.J.; Breuer, Roderick H.J.; Mourik, Johan C. van; Golding, Richard P.; Postmus, Pieter E.

doi:10.1378/chest.120.4.1327

Cited by 99 publications

(69 citation statements)

References 20 publications

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“…Electrocautery and argon plasma coagulation are straightforward techniques enabling simpler clinical application than Nd-YAG laser [61][62][63][64][65]. Therefore, it is logical to extend the use of such a simple technique in treating local tumour growth for superficial early stage cancer in the central airways, as theoretical concepts behind early detection, staging and treatment are more important, rather than focusing on treatment technique per se as a separate entity [9,13,17,18]. …”

Section: Clinical Experience and Resultsmentioning

confidence: 99%

“…Current abilities for accurate TNM staging in the early event of carcinogenesis, together with local intervention (e.g. bronchoscopic treatment), will be implemented increasingly upfront as an alternative to immediate surgical approach at the earliest disease stage [8,10,13,[20][21][22].…”

Section: Nonsurgical Candidatesmentioning

confidence: 99%

“…in the pre-neoplastic and carcinoma in situ stage. Certain individuals with favourable early lesions can be properly identified and a less invasive approach is appropriate in these subjects [13][14][15][16][17][18][19][20]. The time window before microinvasive cancer develops nodal involvement can be exploited by choosing a tailored approach for each particular lesion in the person at risk that better preserves QoL and has superior cost-effectiveness [21,22].…”

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confidence: 99%

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Therapeutic bronchoscopy with immediate effect: laser, electrocautery, argon plasma coagulation and stents

Bolliger¹

2006

Eur Respir J

338

276

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Minimally invasive diagnostic and therapeutic approaches in medicine have been applied for a more selective and tailored approach to reduce patients' morbidity and mortality. The efficacy of interventional pulmonology for palliation of patients with central airways obstruction has been established and its curative potential for intralesional treatment of early cancer has raised great interest in current screening programmes. This is due to the fact that surgical resection and systemic nodal dissection as the gold standard is relatively morbid and risky, especially when dealing with individuals with limited functional reserves due to smoking-related comorbidities, such as chronic obstructive pulmonary disease. Furthermore, such comorbidities have been proven to harbour early stage lesions of several millimetres in size without involvement of nodal disease that may be amenable to local bronchoscopic treatment.Therefore, the success of minimally invasive strategies for palliation and treatment with curative intent strongly depends on the diligent identification of the various factors in lung cancer management, including full comprehension of the limits and potential of each particular technique. Maximal preservation of quality of life is a prerequisite in successfully dealing with individuals at risk of harbouring asymptomatic early lung cancer, to prevent aggressive surgical diagnostic and therapeutic strategies since overdiagnosis remains an issue that is heavily debated.In the palliative setting of alleviating central airway obstruction, laser resection, electrocautery, argon plasma coagulation and stenting are techniques that can provide immediate relief, in contrast to cryotherapy, brachytherapy and photodynamic therapy with delayed effects. With curative intent, intraluminal techniques that easily coagulate early stage cancer lesions will increase the implementation of interventional pulmonology for benign and relatively benign diseases, as well as early cancer lesions and its precursors at their earliest stage of disease.

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Section: Clinical Experience and Resultsmentioning

confidence: 99%

Section: Nonsurgical Candidatesmentioning

confidence: 99%

mentioning

confidence: 99%

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Therapeutic bronchoscopy with immediate effect: laser, electrocautery, argon plasma coagulation and stents

Bolliger¹

2006

Eur Respir J

338

276

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“…Sputum cytology examinations combined with autofluorescence bronchoscopy are increasingly being used for detecting early invasive squamous cell cancer (SCC) as well as carcinoma in situ and its precursor lesions (2,3). Being from a referral center for early intervention (4) and minimal invasive techniques, we have developed strict diagnostic and therapeutic algorithms to select patients who may benefit from intraluminal bronchoscopic treatment (3, 5 -7).…”

mentioning

confidence: 99%

“…Being from a referral center for early intervention (4) and minimal invasive techniques, we have developed strict diagnostic and therapeutic algorithms to select patients who may benefit from intraluminal bronchoscopic treatment (3, 5 -7). In some cases, additional information using 18 F-fluorodeoxyglucose positron emission tomography (FDG-PET) may be useful for additional staging prior to choosing the most appropriate treatment strategy (3,7). In a pilot study, we showed that FDG-PET was able to detect cancer lesions with a diameter of z3 mm (8).…”

mentioning

confidence: 99%

Detection and Staging of Preinvasive Lesions and Occult Lung Cancer in the Central Airways with 18F-Fluorodeoxyglucose Positron Emission Tomography: A Pilot Study

Pasic¹,

Brokx²,

Comans³

et al. 2005

Clinical Cancer Research

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Purpose: To evaluate the role of 18 F-fluorodeoxyglucose positron emission tomography (FDG-PET) in radiologically occult preinvasive lesions and lung cancer in the central airways. Experimental Design:Twenty-two patients with 24 preinvasive lesions and early squamous cell cancer (SCC) being occult on high-resolution computed tomography were studied. All lesions were diagnosed based on histology sampled using autofluorescence bronchoscopy. FDG-PET findings were correlated with WHO histologic classification. FDG-PET was considered truepositive when the final diagnosis was SCC and true-negative when the lesions were classified as severe dysplasia or less. Results: FDG-PET was true-positive in 8 of 11and true-negative in 11of 13 cases corresponding with a sensitivity of 73% [95% confidence interval (CI), 0.43-0.91] and specificity of 85% (95% CI, 0.57-0.97). Positive and negative predictive values were 80% (95% CI, 0.48-0.96) and 79% (95% CI, 0.52-0.93), respectively. Conclusions: Our very preliminary data suggest that FDG-PET might be useful for the evaluation of early central airway lesions, being positive in most SCC and negative in cases of severe dysplasia. Validation in a larger multicenter study is needed.

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Detection of Preneoplastic Lesions

Lam¹

2008

Lung Cancer

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Autofluorescence Bronchoscopy Improves Staging of Radiographically Occult Lung Cancer and Has an Impact on Therapeutic Strategy

Cited by 99 publications

References 20 publications

Therapeutic bronchoscopy with immediate effect: laser, electrocautery, argon plasma coagulation and stents

Therapeutic bronchoscopy with immediate effect: laser, electrocautery, argon plasma coagulation and stents

Detection and Staging of Preinvasive Lesions and Occult Lung Cancer in the Central Airways with 18F-Fluorodeoxyglucose Positron Emission Tomography: A Pilot Study

Detection of Preneoplastic Lesions

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