Chest
Volume 131, Issue 6, June 2007, Pages 1794-1799
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ORIGINAL RESEARCH
INTERVENTIONAL PULMONOLOGY
A Pilot Study of Narrow-Band Imaging Compared to White Light Bronchoscopy for Evaluation of Normal Airways and Premalignant and Malignant Airways Disease

https://doi.org/10.1378/chest.06-2794Get rights and content

Background

The objectives of this study were to characterize the appearance of normal, dysplastic, and frankly malignant airway lesion appearance under narrow-band imaging (NBI), and to determine if NBI, when used in conjunction with white light (WL) bronchoscopy, could improve detection of dysplasia and malignancy.

Patients and methods

This was a prospective, partially blinded study at a university teaching hospital. Bronchoscopy was performed on 22 patients with known or suspected bronchial dysplasia or malignancy. Full airway examination was performed first under WL bronchoscopy and then under NBI. Directed endobronchial biopsies of likely dysplastic, malignant, and normal (control) areas were then performed and sent for examination by a pathologist blinded to the gross description of the lesion. Pathology interpretations were then compared to the corresponding WL and NBI images.

Results

There were one malignant and four dysplastic lesions in 22 patients detected by NBI when findings by WL imaging were considered normal. In cases when the WL appearance was abnormal, NBI did not improve the diagnostic yield. The increased rate of detection of dysplasia and malignancy by NBI was statistically significant (p = 0.005).

Conclusion

NBI identified dysplasia or malignancy that was not detected by WL inspection in 23% of subjects. Further studies are needed to determine the efficacy of NBI in detection of premalignant airways lesions in an at-risk population.

Section snippets

Materials and Methods

This was a prospective, partially blinded study conducted at an academic medical center in the United States over a 6-month period. The study was approved by our investigational review board, and informed consent was obtained from each participant prior to the study.

Patient Characteristics

There were 8 men and 14 women (mean age, 59 years; range, 28 to 77 years). All participants were either current or former smokers (mean, 38 pack-years [packs per day times the number of years smoked]; range, 5 to 100 pack-years). Fifty percent of the participants had a diagnosis of lung cancer, and all of these had received treatment for lung cancer. Three patients underwent surgical resection only, and eight patients underwent chemotherapy and radiation. Patient characteristics are shown in

Discussion

It is estimated that squamous cell carcinoma of the central airways represents up to one third of all lung cancers diagnosed in the United States,22 yet the natural history of bronchial dysplasia is not as well understood. Previous studies232425 estimated that invasive carcinoma will develop in 40 to 83% of patients with severely dysplastic lesions. It has been demonstrated in animal studies2627 that many of these lesions can regress spontaneously, and it has also been suggested that invasive

Conclusions

The addition of NBI to WL bronchoscopy significantly improved detection of bronchial dysplasia compared to WL bronchoscopy alone. NBI requires closer examination both as a stand-alone technology and in comparison with other imaging strategies including AF bronchoscopy in the setting of clinical trials. Future directions include combining NBI with molecular markers in those at high risk for lung cancer.4243

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    This work was supported by a research grant provided by Olympus America Inc.

    The authors have no conflicts of interest to disclose.

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