AUTOFLUORESCENCE BRONCHOSCOPY IN THE DIAGNOSIS OF PRENEOPLASTIC CHANGES AND BRONCHIAL CARCINOMA
Abstract
Background. Fluorescence bronchoscopy is more sensitive than white light bronchoscopy in the diagnosis of preneoplastic changes of bronchial mucosa, carcinoma in situ and invasive bronchial cancer.
Methods. Thirty-one patients, 22 male, 9 female, age 59 ± 11 years were examined with autofluorescence system Storz 11004BI and D-light/AF with camera SL PDD and Olympus 1T30 or 1T40. Local anaesthesia was applied. Bronchial biopsy was performed 3–5 times on macroscopically suspicious and apparently normal sites of bronchial mucosa. Each biopsy site was classified by white light (WLB), autofluorescence bronchoscopy (AFB) and histologically as normal epithelium, moderate dysplasia, severe dysplasia, and carcinoma in situ or invasive carcinoma. The results of WLB and AFB were compared with histological diagnosis.
Results. We confirmed invasive carcinoma in 16, carcinoma in situ in 1 patient, pleural mesothelioma in 1 and benign diseases in 13 patients. Findings were classified as squamous cell (n = 9), small cell (n = 4), adenocarcinoma (n = 3) and unclassifiable (n = 1) carcinoma. Biopsy was performed on 52 sites. Invasive carcinoma was histologically confirmed on 19 biopsy sites. WLB showed invasive carcinoma in 17 cases (89%) and AFB in 18 cases (95%). In the patient with carcinoma in situ WLB found mild dysplastic changes while AFB was positive. WLB sensitivity was 0.85 and AFB 0.95, while specificity of WLB was 0.91 and of AFB was 0.44. Relative sensitivity of WLB + AFB was 1.08 comparing with WLB alone. We observed false positive results because of former biopsies, bleeding, inflammation or scarring in patients with mild dysplasia and normal mucosa with WLB in 1 (3%) and with AFB in 5 (16%) cases.
Conclusions. Autofluorescence was more sensitive than white light bronchoscopy in the diagnosis of invasive bronchial carcinoma, carcinoma in situ and dysplasia. False positive results must be considered.
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References
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