Combination of narrow band imaging (NBI) and autofluorescence imaging (AFI) videobronchoscopy in endoscopic assessment of lung cancer extension

Abstract

Both narrow band imaging (NBI) and autofluorescence imaging (AFI) are new techniques for the assessment of lung cancer. The major aim of this study was to investigate whether the combination of these two techniques improve sensitivity and specificity in the assessment of lung cancer extension. The study prospectively evaluated 118 patients with suspected lung cancer. All of the patients were examined using EVIS LUCERA SPECTRUM videobronchoscopy system. The narrow band imaging preceded autofluorescence imaging examination. In every patient, at least 1 but no more than 4 biopsies were taken from places visualized as pathologic, surrounding primary tumor, and at least 1 biopsy from places that appeared visually normal. Sensitivity, specificity, positive, and negative predictive value for autofluorescence imaging in the assessment of tumor extension were 89.2, 77.8, 87, and 81%, respectively. Sensitivity, specificity, positive, and negative predictive value for narrow band imaging were 90.4, 82.4, 91.8, and 79.7%, respectively. Corresponding values for combination of techniques were 93.7, 86.9, 94.5, and 85.1%. Combination of techniques significantly improves sensitivity (P = 0.034) with borderline effect on specificity (P = 0.056) of autofluorescence imaging. There was no significant improvement for sensitivity and specificity of NBI alone. The combination of techniques shows significantly better sensitivity and specificity in the assessment of lung cancer extension when compared to white light videobronchoscopy alone, but improvement is not so convincing when compared to the each technique alone.

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

“…Table 1 describes these studies' research methods, and Table 2 describes their biopsy results and findings on the sensitivities and specificities of AFI and WLB. Seven of the studies [19][20][21][22][23]49,50 found sensitivity of AFI significantly higher than that of WLB, whereas the remaining study 24 found the sensitivity of AFI not significantly different from WLB. Four of the studies found the specificity of AFI significantly higher than that of WLB, 19,22,23,49 one found the specificity was not different from WLB, 24 and the other 3 found the specificity of AFI significantly lower than that of WLB.…”

“…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.…”

“…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.…”

Diagnoses of endobronchial pretumor pathology and early forms of lung cancer

“…Другие авторы [50][51][52] провели исследования по изучению возможностей NBI для анализа изменений сосудистого рисунка (архитектоники) слизистой оболочки бронхиального дерева при проведении дифференциальной диагностики воспалительных и неопластических изменений.…”