Chest
Volume 118, Issue 6, December 2000, Pages 1776-1782
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Bronchoscopy
Early Detection of Lung Cancer With Laser-Induced Fluorescence Endoscopy and Spectrofluorometry

https://doi.org/10.1378/chest.118.6.1776Get rights and content

Study objectives:

We performed a clinical trial oflaser-induced fluorescence endoscopy (LIFE) for detection ofprecancerous lesions and cancer including carcinoma insitu (CIS), which are difficult to detect by white-lightbronchoscopy.

Design:

Results with LIFE were comparedwith the criterion standard, white-light bronchoscopy. The evaluationof these endoscopic results spectrofluorometrically was examined, andpixels of LIFE images composed of digital signals for the intensitiesof red and green were analyzed.

Setting:

Tertiary-level hospital treating referrals and subjects with suspiciousresults in mass screening.

Patients:

We examined 65subjects with suspected lung cancer by both methods, and performedbiopsy on 216 lesions.

Results:

The accuracy ofdiagnosis by white-light bronchoscopy, with histopathologic results asthe standard, was 48.6%. The accuracy by LIFE was 72.7%. Thesensitivity of conventional bronchoscopy for detection of severedysplasia (21 biopsy specimens) or cancer (28 biopsy specimens) was61.2% and specificity was 85.0%. With results by LIFE added, thesevalues were 89.8% and 78.4%, respectively. Of nine patients with CIS,only LIFE showed one lesion, and only LIFE showed the extent of sevenof the lesions. The autofluorescence of eight lesions was measuredspectrofluorometrically; normal bronchial tissue, severe dysplasia, andcancerous tissue had spectral differences. The red/green intensity ofcancers on histograms of LIFE images generally was greater than theratios for metaplasia or normal bronchial wall.

Conclusions:

Use of both methods should facilitate earlydetection. Evaluation by spectrofluorometry and analysis of digitalsignal intensity of results by LIFE make results moreobjective.

Section snippets

Subjects

A total of 65 subjects underwent bronchoscopy with LIFE. Weperformed a radiographic examination of heavy smokers identified asbelonging to a high-risk group during mass screening for lung cancer, made available to individuals aged ≥ 40 years residing in any ofseven cities in Osaka Prefecture, and examined sputum specimenscytologically. Results of the sputum examination called for furtherstudy of 26 patients, who were enrolled in our trial of bronchoscopywith LIFE. Another 21 patients presented

Results

The mean cigarette index (packs of cigarettes per day times yearsat that consumption rate) for the 63 smokers was 55 packs (range, 5 to140 packs), and two patients were nonsmokers. In all, 216 sitesunderwent biopsy. The histopathologic diagnoses of the specimens wereas follows. Forty-six findings were normal. Of the 142 nonmalignantlesions, 28 were of inflammation or hyperplasia, 49 were of milddysplasia, 44 were of moderate dysplasia, and 21 were of severedysplasia (precancerous). Of the 23

Discussion

The combination of conventional bronchoscopy and LIFE can improvedetection of endobronchial lesions.1314 We found thesensitivity in detection of severe dysplasia and cancer, including CIS,by this combination to be 29 percentage points higher (improvement byslightly less than 50%) than by conventional bronchoscopy alone. Thespecificity with this combination was lower by about 7 percentagepoints. We concluded that all sites considered suspicious by eithermethod should be examined.

The extent of

References (17)

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