Autofluorescence Videobronchoscopy (AFI) for the Assessment of Tumor Extension in Lung Cancer

Abstract

The major objective of our study was to determine the specificity and sensitivity of AFI videobronchoscopy vs. white light videobronchoscopy, in the assessment of lung cancer extent.Secondary objective was to investigate whether or not AFI can reveal greater extension of the tumor, and can it influence therapy making decision. Autofluorescence videobronchoscopy systems are new technology for visualization of bronchial mucosa, and the proper indications for such systems will be determined in the near future. In this prospective trial we have enrolled 27 patients with suspected lung cancer in whom we performed 108 diagnostic biopsies and 54 control biopsies. All patients underwent WL videobronchoscopy followed by Auto Fluorescence Imaging (AFI) examination of tracheobronchial tree. We were using videobronchoscope BF-F260 and EVIS LUCERA SPECTRUM processor unit. Overall specificity for AFI in the diagnostics of lung cancer was found to be 85%, sensitivity was 90%, positive predictive value (PPV) 78%, and negative predictive value (NPV) 94%. Specificity, sensitivity, PPV, and NPV for WL videobronchoscopy in lung cancer diagnostics were 54%, 64%, 51%, and 69%, respectively. Relative sensitivity ratio of AFI over WL videobronchoscopy, which is calculated to be 1.41, confirmed superiority of AFI in lung cancer diagnostics.We confirmed significant correlation between the greater extension of the tumor (assessed with AFI) and the therapeutical decision in lung cancer treatment (p = 0.01). Influence of AFI on therapeutical decision was significant (p = 0.034). AFI videobronchoscopy system yields significantly higher sensitivity and specificity for the assessment of lung cancer extent than WLB videobronchoscopy alone. It had shown to be able to influence therapeutic option for lung cancer treatment. Further studies are needed to evaluate and validate these results.

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

“…11,13,40,41 AFI has shown significantly higher sensitivity in almost all the studies to date. Some studies 19,22,23,49 have found that AFI has superior specificity to WLB, while some other studies have found sim- ilar or lower specificity. 20,21,24 Whether AFI can improve detection of lung cancer or precancerous lesions is still controversial.…”

“…Some studies have found that AFI is better than WLB for detecting superficial cancers and precancerous lesions, [19][20][21][22][23] whereas some other studies have reported controversial results. 24 In this paper we describe the working mechanisms and characteristics of AFBs, mainly AFI, and the diagnostic performance of AFI for detecting lung cancers and precancerous lesions.…”

“…Biopsies with a histology grade of moderate dysplasia or worse were considered positive. In the studies by Zaric et al, 22,23 red/brownish or magentacolored areas were considered positive via AFI, and biopsies with a histology grade of carcinoma were considered positive.…”

“…Cetti et al 24 evaluated the diagnostic performance of AFI in lung cancer, and recruited patients with suspected lung cancer, and excluded patients with already diagnosed central-airway lung cancer. Zaric et al 22,23,49 evaluated AFI in the assessment of tumor extent (margins), and recruited patients with suspected lung cancer, and excluded patients with suspected or known lung cancer metastases.…”

“…Three studies by Zaric et al 22,23,49 evaluated AFI for assessing tumor extent, and the biopsies were taken from the margins of the visualized pathologic mucosa. The other studies [19][20][21]24,50 were designed to evaluate AFI in the diagnosis of cancers and precancerous lesions, and the biopsies were taken from the cores of the suspicious areas, under either AFI or WLB.…”