Autofluorescence bronchoscopy with white light bronchoscopy compared with white light bronchoscopy alone for the detection of precancerous lesions: a European randomised controlled multicentre trial

Abstract

Background: The potential of autofluorescence bronchoscopy (AFB) to detect precancerous lesions in the central airways and its role in lung cancer screening is uncertain. A study was undertaken to evaluate the prevalence of moderate/severe dysplasia (dysplasia II-III) and carcinoma in situ (CIS) using a newly developed AFB system in comparison with conventional white light bronchoscopy (WLB) alone. Methods: In a prospective randomised multicentre trial, smokers >40 years of age (>20 pack-years) were stratified into four different risk groups and investigated with either WLB+AFB (arm A) or WLB alone (arm B). Results: 1173 patients (916 men) of mean age 58.7 years were included. Overall (arms A and B), preinvasive lesions (dysplasia II-III and CIS) were detected in 3.9% of the patients. The prevalence of patients with preinvasive lesions in the WLB arm was 2.7% compared with 5.1% in the WLB+AFB arm (p = 0.037). For patients with dysplasia II-III, WLB+AFB increased the detection rate by a factor of 2.1 (p = 0.03), while for CIS the factor was only 1.24 (p = 0.75). The biopsy based sensitivity of WLB alone and WLB+AFB for detecting dysplasia II-III and CIS was 57.9% compared with 82.3% (1.42-fold increase). The corresponding specificity was 62.1% compared with 58.4% (0.94-fold decrease).Conclusions: This first randomised study of AFB showed that the combination of WLB+AFB was significantly superior to WLB alone in detecting preneoplastic lesions. Our findings do not support the general use of AFB as a screening tool for lung cancer, but suggest that it may be of use in certain groups. The precise indications await further study.

Value of Autofluorescence Imaging Videobronchoscopy in Detecting Lung Cancers and Precancerous Lesions: A Review

“…Among the studies [37][38][39][40][41][42][43][44][45][46][47][48] of AFB versus WLB for detecting cancers and precancerous lesions, most have concluded that AFB has a much higher sensitivity and a lower specificity than WLB. 11,13,40,41 AFI has shown significantly higher sensitivity in almost all the studies to date.…”

Autofluorescence Bronchoscopy and Endobronchial Ultrasound

“…The investigators found that AFB + WLB had a relative sensitivity of 6.3 compared to WLB alone. The specificity of AFB was 66%.Many subsequent literature studies (Level of evidence: III) including varying categories of patients with known/suspected lung cancer, or at high-risk of developing lung cancer, confirmed the superiority of AFB + WLB versus WLB in the detection of dysplasia and CIS, even though the relative sensitivity of AFL + WLB was usually found to be lower than that reported in the 1998 study by Lam et coll [10][11][12][13].More recently, the first prospective, randomised, multicentric study compared WLB + AFB versus WLB in 1173 smokers with additional risk factors for lung cancer (Level of evidence: Ib) [4]. The results of this study confirmed the superiority of AFB over WLB in the detection of preneoplastic and early neoplastic lesions, but did not support the high expectations raised by many previous studies.…”

“…Second, the relative sensitivity of WLB + AFB versus WLB alone found in this study (1.42) was much lower than in many previous studies, and the superiority of AFB over WLB was statistically significant only for moderate/severe dysplasia and not for CIS. The specificity was 58% for WLB + AFB, and 62% for WLB alone.In conclusion, the experience with AFB accumulated so far suggests that [1,3,4,[10][11][12][13][14]: 1) this method is superior to WLB alone, especially in the detection of preneoplastic lesions (moderate to severe dysplasia); 2) it is quite clear that this depends mainly on the sensitivity of WLB. In those studies where the sensitivity was particularly low [Lam] the relative sensitivity of AFB + WLB versus WLB alone was markedly higher; 3) the prevalence of preneoplastic lesions in the population being studied is extremely important, and it has proved highly variable in studies into AFB published thus far.…”

The clinical value of autofluorescence bronchoscopy for precancerous lesions in operable primary lung cancer patients

“…BIB ve OFB'de patoloji saptanmayan bölgeler biyopsisiz gerçek negatif kabul edilmiştir. Bir çalışmada rastgele alınan biyopsilerin ekonomik maliyeti artırdığı ve BIB + OFB'nin bu biyopsiler alınmadan daha efektif olabileceği bildirilmiştir (15).…”