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Wang G, Jin Y, Xiong K, Jin X, Wang L, Li C. Utility of auto fluorescence-guided biopsy in suspected lung cancer patients with bronchial mucosal lesions. Photodiagnosis Photodyn Ther 2024; 46:104057. [PMID: 38508439 DOI: 10.1016/j.pdpdt.2024.104057] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2023] [Revised: 03/15/2024] [Accepted: 03/18/2024] [Indexed: 03/22/2024]
Abstract
BACKGROUND Bronchoscopy is currently the most common technique for lung cancer diagnosis. Patients suspected of malignancy often undergo bronchoscopic examination, and biopsy is routinely used in patients with visible bronchial lesions. However, it is difficult to differentially diagnose lung cancer in patients with bronchial mucosal lesions. Thus, this study was conducted to investigate the utility of fluorescence-guided biopsy in suspected lung cancer patients with bronchial mucosal lesions. METHODS We conducted a retrospective study in a single screening center to assess the sensitivity and specificity of fluorescence-guided biopsy compared with white light bronchoscopy (WLB) in patients with bronchial mucosal lesions. RESULTS A total of 301 patients with bronchial mucosal lesions were enrolled in this study. The sensitivity for patients with fluorescence-guided biopsy was 60.3 % (95 % confidence interval [CI]: 53.1 %-67.1 %), which was higher than that of patients with WLB alone (45.2 %, 95 % CI: 38.2-52.4 %) (P = 0.0026). Additionally, compared with the WLB group, the fluorescence -guided biopsy group was found to have a significantly higher specificity (100 %, 95 % CI: 95.5-100 % versus 69.6 %, 95 % CI: 59.6-78.1 %), positive predictive value (100 %, 95 % CI: 96.1-100 % versus 74.3 %, 95 % CI: 65.5-81.7 %) and negative predictive value (56.3 %, 95 % CI: 48.8-63.6 % versus 39.4 %, 95 % CI: 32.3-47.0 %). CONCLUSION Fluorescence-guided biopsy can serve as an important adjunct to WLB for the differential diagnosis of lung cancer in patients with bronchial mucosal lesions.
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Affiliation(s)
- Gaozhe Wang
- Department of Respiratory and Critical Care Medicine, Key Laboratory of Respiratory Disease of Ningbo, The First Affiliated Hospital of Ningbo University, Ningbo, China; School of Medicine, Ningbo University, Ningbo, Zhejiang, China
| | - Yan Jin
- Department of Respiratory and Critical Care Medicine, Key Laboratory of Respiratory Disease of Ningbo, The First Affiliated Hospital of Ningbo University, Ningbo, China
| | - Kunlong Xiong
- Department of Respiratory and Critical Care Medicine, Key Laboratory of Respiratory Disease of Ningbo, The First Affiliated Hospital of Ningbo University, Ningbo, China
| | - Xiaoyan Jin
- Department of Respiratory and Critical Care Medicine, Key Laboratory of Respiratory Disease of Ningbo, The First Affiliated Hospital of Ningbo University, Ningbo, China
| | - Linfeng Wang
- Department of Respiratory and Critical Care Medicine, Key Laboratory of Respiratory Disease of Ningbo, The First Affiliated Hospital of Ningbo University, Ningbo, China.
| | - Chenwei Li
- Department of Cerebral Surgery, The First Affiliated Hospital of Ningbo University, Ningbo, China.
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Morikawa K, Izawa N, Kida H, Handa H, Inoue T, Mineshita M. Detection of a pinhole-sized bronchoesophageal fistula under bronchoscopic autofluorescence imaging. Thorac Cancer 2021; 12:2043-2045. [PMID: 34002538 PMCID: PMC8258352 DOI: 10.1111/1759-7714.14008] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2021] [Revised: 05/01/2021] [Accepted: 05/03/2021] [Indexed: 11/28/2022] Open
Abstract
Autofluorescence imaging (AFI) is a technique for detecting early‐stage lung cancer by amplifying the difference in autofluorescence of the bronchial mucosa. However, there are few reports detailing its other applications. Here, we report the case of a 54‐year‐old woman with stage IVa esophageal cancer who completed chemoradiation therapy, but developed a bronchoesophageal fistula at the left main bronchus and underwent fasting treatment. Computed tomography confirmed that the fistula had closed; however, she subsequently developed aspiration pneumonia and underwent bronchoscopy for confirmation. Although it was difficult to identify the site of the pinhole bronchoesophageal fistula under white light, AFI could easily identify the fistula and digestive mucus in light magenta. AFI may therefore be worth considering for the detection of pinhole bronchoesophageal fistulas.
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Affiliation(s)
- Kei Morikawa
- Division of Respiratory Diseases, Department of Internal Medicine, St. Marianna University School of Medicine, Kawasaki, Japan
| | - Naoki Izawa
- Department of Clinical Oncology, St. Marianna University School of Medicine, Kawasaki, Japan
| | - Hirotaka Kida
- Division of Respiratory Diseases, Department of Internal Medicine, St. Marianna University School of Medicine, Kawasaki, Japan
| | - Hiroshi Handa
- Division of Respiratory Diseases, Department of Internal Medicine, St. Marianna University School of Medicine, Kawasaki, Japan
| | - Takeo Inoue
- Division of Respiratory Diseases, Department of Internal Medicine, St. Marianna University School of Medicine, Kawasaki, Japan
| | - Masamichi Mineshita
- Division of Respiratory Diseases, Department of Internal Medicine, St. Marianna University School of Medicine, Kawasaki, Japan
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Abdelhady AM, Abdallah DMM. Role of I-scan technique in screening for lung cancer in smokers with positive sputum cytology. THE EGYPTIAN JOURNAL OF BRONCHOLOGY 2020. [DOI: 10.1186/s43168-020-00002-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Abstract
Abstract
Background
Lung cancer has a very poor prognosis and high mortality. Positive sputum for malignant and/or atypical cells warrants the need for fibreoptic bronchoscopy. White light bronchoscopy (WLB) is usually unable to detect preinvasive lesions; therefore, autofluorescence bronchoscopy (AFB) was introduced as a gold standard for detecting such lesions. The aim of this work was to investigate the role of I-scan as a screening tool for cancer in smoker patients showing positive sputum cytology.
Results
New suspicious findings under I-scan occurred in 11 patients (36.7%). The overall sensitivity of WLB alone to diagnose malignancy is 23.3%, in contrast to an added sensitivity of 50% when I-scan was combined with white light (p value < 0.05). The specificity of I-scan could not be assessed in the absence of control cases (true negatives). No major complications or deaths occurred. Haemorrhage and bronchospasm were the commonest minor complications.
Conclusions
The addition of I-scan to the routine white light examination can increase the overall sensitivity of bronchoscopic screening in cases of sputum suspicious for malignancy if put in experienced hand. The suggested increase in procedure duration due to the combined use of I-scan and white light bronchoscopy is not associated with life-threatening complications.
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Sun S, Yang Y, Chen M, Wang L, Pan H, Zhang X, Wagnieres G, Mohammad Y, Barreiro E, Pirozzolo G, Villeneuve PJ, Zhan P, Wan B. Comparison of autofluorescence and white-light bronchoscopies performed with the Evis Lucera Spectrum for the detection of bronchial cancers: a meta-analysis. Transl Lung Cancer Res 2020; 9:23-32. [PMID: 32206550 PMCID: PMC7082289 DOI: 10.21037/tlcr.2020.01.04] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/07/2023]
Abstract
Background Many recent studies have reported that autofluorescence bronchoscopy (AFB) has a superior sensitivity and decreased specificity in the diagnosis of bronchial cancers when compared with white-light bronchoscopy (WLB). We specifically analyzed the diagnostic performances of autofluorescence imaging video bronchoscopy (AFI) performed with the Evis Lucera Spectrum from Olympus, which is a relatively novel approach in detecting and delineating bronchial cancers, and compared it to the older WLB method. Methods We searched the PubMed, Embase, Web of Science, and CNKI databases from inception to July 12th, 2018 for trials in which patients were diagnosed with lung cancer via concurrent or combined use of AFI and WLB. The included studies were required to have a histologic diagnosis as the gold standard comparison, and a sufficient amount of data was extracted to assess the diagnostic capacity. A 2×2 table was constructed, and the area under the receiver-operating characteristic curve (AUC) of AFI and WLB was estimated by using a stochastic model for diagnostic meta-analysis using STATA software. Results A total of 10 articles were eligible for the meta analysis, comprising 1,830 patients with complete data included in the analysis. AFI showed a superior sensitivity of 0.92 (95% CI, 0.88-0.95) over WLB's 0.70 (95% CI, 0.58-0.80) with P<0.01, and a comparable specificity of 0.67 (95% CI, 0.51-0.80) compared with WLB's 0.78 (95% CI, 0.68-0.86) with P=0.056. Egger's test P value (0.225) demonstrated that there was no publication bias. Conclusions Our research showed that in the evaluation of bronchial cancers, AFI was superior to conventional WLB. With its higher sensitivity, AFI could be valuable for avoiding misdiagnosis.
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Affiliation(s)
- Shuangshuang Sun
- Department of Respiratory Medicine, The Affiliated Hospital of Jiangsu University, Zhenjiang 212001, China.,Department of Respiratory and Critical Care Medicine, the Affiliated Jiangning Hospital of Nanjing Medical University, Nanjing 210002, China
| | - Yang Yang
- Department of Respiratory and Critical Care Medicine, the Affiliated Jiangning Hospital of Nanjing Medical University, Nanjing 210002, China
| | - Meizi Chen
- Department of Respiratory and Critical Care Medicine, Chenzhou No.1 People's Hospital, Chenzhou 423000, China
| | - Li Wang
- Department of Respiratory and Critical Care Medicine, the Affiliated Jiangning Hospital of Nanjing Medical University, Nanjing 210002, China
| | - Hangcheng Pan
- Department of Respiratory and Critical Care Medicine, the Affiliated Jiangning Hospital of Nanjing Medical University, Nanjing 210002, China
| | - Xiuwei Zhang
- Department of Respiratory and Critical Care Medicine, the Affiliated Jiangning Hospital of Nanjing Medical University, Nanjing 210002, China
| | - Georges Wagnieres
- Laboratory for Functional and Metabolic Imaging, Institute of Physics, Swiss Federal Institute of Technology in Lausanne (EPFL), Station 6, Bâtiment de Chimie, Lausanne, Switzerland
| | - Yousser Mohammad
- National Center for Research on Chronic Respiratory Diseases, Tishreen University, Tishreen Hospital, Latakia, Syria.,Department of Internal Medicine, 6-Syrian Private University, Damascus, Syria
| | - Esther Barreiro
- Pulmonology Department-Muscle Wasting & Cachexia in Chronic Respiratory Diseases & Lung Cancer Research Group, IMIM-Hospital del Mar, Parc de Salut Mar, Barcelona, SpainCentro de Investigación en Red de Enfermedades Respiratorias (CIBERES), Instituto de Salud Carlos III (ISCIII), Barcelona, Spain
| | | | - P James Villeneuve
- Cancer Therapeutics Program, Ottawa Hospital Research Institute, Ottawa, ON, Canada
| | - Ping Zhan
- Department of Respiratory Medicine, Jinling Hospital, Nanjing University of Medicine, Nanjing 210002, China.,Nanjing University Institute of Respiratory Medicine, Nanjing 210002, China
| | - Bing Wan
- Department of Respiratory and Critical Care Medicine, the Affiliated Jiangning Hospital of Nanjing Medical University, Nanjing 210002, China
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Atta EM, Helal SMF, Daabis RGA, Abdallah AA, Yehya AMI. Use of videobronchoscopic narrow band imaging compared with white light in diagnosing some bronchopulmonary diseases. THE EGYPTIAN JOURNAL OF BRONCHOLOGY 2018. [DOI: 10.4103/ejb.ejb_12_17] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/13/2023] Open
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McGregor HC, Short MA, McWilliams A, Shaipanich T, Ionescu DN, Zhao J, Wang W, Chen G, Lam S, Zeng H. Real-time endoscopic Raman spectroscopy for in vivo early lung cancer detection. JOURNAL OF BIOPHOTONICS 2017; 10:98-110. [PMID: 26748689 DOI: 10.1002/jbio.201500204] [Citation(s) in RCA: 39] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/30/2015] [Revised: 10/22/2015] [Accepted: 11/24/2015] [Indexed: 05/09/2023]
Abstract
Currently the most sensitive method for localizing lung cancers in central airways is autofluorescence bronchoscopy (AFB) in combination with white light bronchoscopy (WLB). The diagnostic accuracy of WLB + AFB for high grade dysplasia (HGD) and carcinoma in situ is variable depending on physician's experience. When WLB + AFB are operated at high diagnostic sensitivity, the associated diagnostic specificity is low. Raman spectroscopy probes molecular vibrations and gives highly specific, fingerprint-like spectral features and has high accuracy for tissue pathology classification. In this study we present the use of a real-time endoscopy Raman spectroscopy system to improve the specificity. A spectrum is acquired within 1 second and clinical data are obtained from 280 tissue sites (72 HGDs/malignant lesions, 208 benign lesions/normal sites) in 80 patients. Using multivariate analyses and waveband selection methods on the Raman spectra, we have demonstrated that HGD and malignant lung lesions can be detected with high sensitivity (90%) and good specificity (65%).
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Affiliation(s)
- Hanna C McGregor
- Imaging Unit - Integrative Oncology Department, BC Cancer Agency Research Centre, Vancouver, British Columbia, Canada
- Interdisciplinary Oncology Program, University of British Columbia, Vancouver, British Columbia, Canada
| | - Michael A Short
- Imaging Unit - Integrative Oncology Department, BC Cancer Agency Research Centre, Vancouver, British Columbia, Canada
| | - Annette McWilliams
- Imaging Unit - Integrative Oncology Department, BC Cancer Agency Research Centre, Vancouver, British Columbia, Canada
| | - Tawimas Shaipanich
- Imaging Unit - Integrative Oncology Department, BC Cancer Agency Research Centre, Vancouver, British Columbia, Canada
- Department of Medicine, University of British Columbia, Vancouver, British Columbia, Canada
| | - Diana N Ionescu
- Department of Pathology and Laboratory Medicine, University of British Columbia, Vancouver, British Columbia, Canada
| | - Jianhua Zhao
- Imaging Unit - Integrative Oncology Department, BC Cancer Agency Research Centre, Vancouver, British Columbia, Canada
| | - Wenbo Wang
- Imaging Unit - Integrative Oncology Department, BC Cancer Agency Research Centre, Vancouver, British Columbia, Canada
| | - Guannan Chen
- Imaging Unit - Integrative Oncology Department, BC Cancer Agency Research Centre, Vancouver, British Columbia, Canada
| | - Stephen Lam
- Imaging Unit - Integrative Oncology Department, BC Cancer Agency Research Centre, Vancouver, British Columbia, Canada
- Interdisciplinary Oncology Program, University of British Columbia, Vancouver, British Columbia, Canada
- Department of Medicine, University of British Columbia, Vancouver, British Columbia, Canada
| | - Haishan Zeng
- Imaging Unit - Integrative Oncology Department, BC Cancer Agency Research Centre, Vancouver, British Columbia, Canada
- Interdisciplinary Oncology Program, University of British Columbia, Vancouver, British Columbia, Canada
- Department of Pathology and Laboratory Medicine, University of British Columbia, Vancouver, British Columbia, Canada
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Zhang J, Wu J, Yang Y, Liao H, Xu Z, Hamblin LT, Jiang L, Depypere L, Ang KL, He J, Liang Z, Huang J, Li J, He Q, Liang W, He J. White light, autofluorescence and narrow-band imaging bronchoscopy for diagnosing airway pre-cancerous and early cancer lesions: a systematic review and meta-analysis. J Thorac Dis 2016; 8:3205-3216. [PMID: 28066600 DOI: 10.21037/jtd.2016.11.61] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
BACKGROUND We aimed to summarize the diagnostic accuracy of white light bronchoscopy (WLB) and advanced techniques for airway pre-cancerous lesions and early cancer, such as autofluorescence bronchoscopy (AFB), AFB combined with WLB (AFB + WLB) and narrow-band imaging (NBI) bronchoscopy. METHODS We searched for eligible studies in seven electronic databases from their date of inception to Mar 20, 2015. In eligible studies, detected lesions should be confirmed by histopathology. We extracted and calculated the 2×2 data based on the pathological criteria of lung tumor, including high-grade lesions from moderate dysplasia (MOD) to invasive carcinoma (INV). Random-effect model was used to pool sensitivity, specificity, diagnostic odds ratio (DOR) and the area under the receiver-operating characteristic curve (AUC). RESULTS In 53 eligible studies (39 WLB, 39 AFB, 17 AFB + WLB, 6 NBI), diagnostic performance for high-grade lesions was analyzed based on twelve studies (10 WLB, 7 AFB, 7 AFB + WLB, 1 NBI), involving with totally 2,880 patients and 8,830 biopsy specimens. The sensitivity, specificity, DOR and AUC of WLB were 51% (95% CI, 34-68%), 86% (95% CI, 73-84%), 6 (95% CI, 3-13) and 77% (95% CI, 73-81%). Those of AFB and AFB + WLB were 93% (95% CI, 77-98%) and 86% (95% CI, 75-97%), 52% (95% CI, 37-67%) and 71% (95% CI, 56-87%), 15 (95% CI, 4-57) and 16 (95% CI, 6-41), and 76% (95% CI, 72-79%) and 82% (95% CI, 78-85%), respectively. NBI presented 100% sensitivity and 43% specificity. CONCLUSIONS With higher sensitivity, advanced bronchoscopy could be valuable to avoid missed diagnosis. Combining strategy of AFB and WLB may contribute preferable diagnosis rather than their alone use for high-grade lesions. Studies of NBI warrants further investigation for precancerous lesions.
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Affiliation(s)
- Jianrong Zhang
- Department of Thoracic Surgery and Oncology, the First Affiliated Hospital of Guangzhou Medical University, Guangzhou 510120, China;; China State Key Laboratory of Respiratory Disease, Guangzhou Institute of Respiratory Disease, Guangzhou 510120, China;; National Clinical Research Centre of Respiratory Disease, Guangzhou 510120, China;; Graduate School, Guangzhou Medical University, Guangzhou 510120, China
| | - Jieyu Wu
- Graduate School, Guangzhou Medical University, Guangzhou 510120, China;; Department of Pathology, the First Affiliated Hospital of Guangzhou Medical University, Guangzhou 510120, China
| | - Yujing Yang
- Department of Clinical Laboratory, Guangdong Academy of Medical Sciences and General Hospital, Guangzhou 510120, China
| | - Hua Liao
- Department of Respiratory Medicine, the Fifth Affiliated Hospital of Southern Medical University, Guangzhou 510120, China
| | - Zhiheng Xu
- China State Key Laboratory of Respiratory Disease, Guangzhou Institute of Respiratory Disease, Guangzhou 510120, China;; National Clinical Research Centre of Respiratory Disease, Guangzhou 510120, China;; Graduate School, Guangzhou Medical University, Guangzhou 510120, China;; Department of Critical Care Medicine, the First Affiliated Hospital of Guangzhou Medical University, Guangzhou 510120, China
| | - Lindsey Tristine Hamblin
- Institute of International Education, Guangdong University of Foreign Studies, Guangzhou 510120, China
| | - Long Jiang
- Department of Thoracic Surgery and Oncology, the First Affiliated Hospital of Guangzhou Medical University, Guangzhou 510120, China;; China State Key Laboratory of Respiratory Disease, Guangzhou Institute of Respiratory Disease, Guangzhou 510120, China;; National Clinical Research Centre of Respiratory Disease, Guangzhou 510120, China;; Graduate School, Guangzhou Medical University, Guangzhou 510120, China
| | - Lieven Depypere
- Department of Thoracic Surgery, University Hospitals Leuven, Leuven, Belgium
| | - Keng Leong Ang
- Department of Thoracic Surgery, Glenfield Hospital, Leicester, LE3 9QP, UK
| | - Jiaxi He
- Department of Thoracic Surgery and Oncology, the First Affiliated Hospital of Guangzhou Medical University, Guangzhou 510120, China;; China State Key Laboratory of Respiratory Disease, Guangzhou Institute of Respiratory Disease, Guangzhou 510120, China;; National Clinical Research Centre of Respiratory Disease, Guangzhou 510120, China;; Graduate School, Guangzhou Medical University, Guangzhou 510120, China
| | - Ziyan Liang
- Department of Neonatology, the Third Affiliated Hospital of Guangzhou Medical University, Guangzhou 510120, China
| | - Jun Huang
- Medical Equipment Section, the Third Affiliated Hospital of Sun Yat-sen University, Guangzhou 510120, China
| | - Jingpei Li
- Department of Thoracic Surgery and Oncology, the First Affiliated Hospital of Guangzhou Medical University, Guangzhou 510120, China;; China State Key Laboratory of Respiratory Disease, Guangzhou Institute of Respiratory Disease, Guangzhou 510120, China;; National Clinical Research Centre of Respiratory Disease, Guangzhou 510120, China
| | - Qihua He
- Department of Thoracic Surgery and Oncology, the First Affiliated Hospital of Guangzhou Medical University, Guangzhou 510120, China;; China State Key Laboratory of Respiratory Disease, Guangzhou Institute of Respiratory Disease, Guangzhou 510120, China;; National Clinical Research Centre of Respiratory Disease, Guangzhou 510120, China;; Graduate School, Guangzhou Medical University, Guangzhou 510120, China
| | - Wenhua Liang
- Department of Thoracic Surgery and Oncology, the First Affiliated Hospital of Guangzhou Medical University, Guangzhou 510120, China;; China State Key Laboratory of Respiratory Disease, Guangzhou Institute of Respiratory Disease, Guangzhou 510120, China;; National Clinical Research Centre of Respiratory Disease, Guangzhou 510120, China
| | - Jianxing He
- Department of Thoracic Surgery and Oncology, the First Affiliated Hospital of Guangzhou Medical University, Guangzhou 510120, China;; China State Key Laboratory of Respiratory Disease, Guangzhou Institute of Respiratory Disease, Guangzhou 510120, China;; National Clinical Research Centre of Respiratory Disease, Guangzhou 510120, China
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8
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Accuracy of autofluorescence in diagnosing oral squamous cell carcinoma and oral potentially malignant disorders: a comparative study with aero-digestive lesions. Sci Rep 2016; 6:29943. [PMID: 27416981 PMCID: PMC4945954 DOI: 10.1038/srep29943] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2016] [Accepted: 06/24/2016] [Indexed: 02/05/2023] Open
Abstract
Presently, various studies had investigated the accuracy of autofluorescence in diagnosing oral squamous cell carcinoma (OSCC) and oral potentially malignant disorders (OPMD) with diverse conclusions. This study aimed to assess its accuracy for OSCC and OPMD and to investigate its applicability in general dental practice. After a comprehensive literature search, a meta-analysis was conducted to calculate the pooled diagnostic indexes of autofluorescence for premalignant lesions (PML) and malignant lesions (ML) of the oral cavity, lung, esophagus, stomach and colorectum and to compute indexes regarding the detection of OSCC aided by algorithms. Besides, a u test was performed. Twenty-four studies detecting OSCC and OPMD in 2761 lesions were included. This demonstrated that the overall accuracy of autofluorescence for OSCC and OPMD was superior to PML and ML of the lung, esophagus and stomach, slightly inferior to the colorectum. Additionally, the sensitivity and specificity for OSCC and OPMD were 0.89 and 0.8, respectively. Furthermore, the specificity could be remarkably improved by additional algorithms. With relatively high accuracy, autofluorescence could be potentially applied as an adjunct for early diagnosis of OSCC and OPMD. Moreover, approaches such as algorithms could enhance its specificity to ensure its efficacy in primary care.
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Mascaux C, Peled N, Garg K, Kato Y, Wynes MW, Hirsch FR. Early detection and screening of lung cancer. Expert Rev Mol Diagn 2014; 10:799-815. [PMID: 20843203 DOI: 10.1586/erm.10.60] [Citation(s) in RCA: 35] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Affiliation(s)
- Celine Mascaux
- University of Colorado Denver, Anschutz Medical Campus, 12801 East 17th Avenue, Aurora, CO 80045, USA.
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10
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Iga N, Oto T, Okada M, Harada M, Nishikawa H, Miyoshi K, Otani S, Sugimoto S, Yamane M, Toyooka S, Miyoshi S. Detection of airway ischaemic damage after lung transplantation by using autofluorescence imaging bronchoscopy. Eur J Cardiothorac Surg 2013; 45:509-13. [PMID: 23999558 DOI: 10.1093/ejcts/ezt437] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/18/2022] Open
Abstract
OBJECTIVES Airway complications related to ischaemia are a major cause of morbidity after lung transplantation. Early detection of airway ischaemia and optimal management of the anastomotic site could reduce the risk of airway complications. Autofluorescence imaging (AFI) bronchoscopy has been increasingly recognized as an effective technique for detecting abnormal mucosal thickening. The aim of this study was to investigate whether AFI bronchoscopy can facilitate the detection of airway ischaemic damage in lung transplant patients. METHODS Twenty Landrace pigs were used to create a tracheal autotransplantation model. A four-ring length of trachea was excised and implanted orthotopically. The tracheal autograft was observed on postoperative days 0, 2, 4 and 7 with AFI bronchoscopy. The extent and origin of graft autofluorescence were examined using histology and measured according to fluorescence intensity. RESULTS The lesions on the tracheal autografts appeared as bright green fluorescence on AFI bronchoscopy. On confocal fluorescence microscopy, high-intensity green fluorescence was observed in the elastin fibre layer of the submucosa. The fluorescence intensity of elastin was significantly higher in the graft showing fluorescence than the graft that did not show fluorescence and that at the control site. CONCLUSIONS Bright green fluorescence was seen in an elastin fibre layer in the submucosa, which was likely a result of epithelial sloughing. There is a close relationship between the bright green fluorescence pattern observed using AFI bronchoscopy and airway ischaemic damage. We conclude that AFI bronchoscopy may detect airway ischaemic damage after lung transplantation.
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Affiliation(s)
- Norichika Iga
- Department of General Thoracic Surgery, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Science, Okayama, Japan
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Wisnivesky JP, Yung RCW, Mathur PN, Zulueta JJ. Diagnosis and treatment of bronchial intraepithelial neoplasia and early lung cancer of the central airways: Diagnosis and management of lung cancer, 3rd ed: American College of Chest Physicians evidence-based clinical practice guidelines. Chest 2013; 143:e263S-e277S. [PMID: 23649442 DOI: 10.1378/chest.12-2358] [Citation(s) in RCA: 42] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022] Open
Abstract
BACKGROUND Bronchial intraepithelial lesions may be precursors of central airway lung carcinomas. Identification and early treatment of these preinvasive lesions might prevent progression to invasive carcinoma. METHODS We systematically reviewed the literature to develop evidence-based recommendations regarding the diagnosis and treatment of intraepithelial lesions. RESULTS The risk and timeline for progression of bronchial intraepithelial lesions to carcinoma in situ (CIS) or invasive carcinoma are not well understood. Multiple studies show that autofluorescence bronchoscopy (AFB) is more sensitive that white light bronchoscopy (WLB) to identify these lesions. In patients with severe dysplasia or CIS in sputum cytology who have chest imaging studies showing no localizing abnormality, we suggest use of WLB; AFB may be used as an adjunct when available. Patients with known severe dysplasia or CIS of central airways should be followed with WLB or AFB, when available. WLB or AFB is also suggested for patients with early lung cancer who will undergo resection for delineation of tumor margins and assessment of synchronous lesions. However, AFB is not recommended prior to endobronchial therapy for CIS or early central lung cancer. Several endobronchial techniques are recommended for the treatment of patients with superficial limited mucosal lung cancer who are not candidates for resection. CONCLUSION Additional information is needed about the natural history and rate of progression of preinvasive central airway lesions. Patients with severe dysplasia or CIS may be treated endobronchially; however, it remains unclear if these therapies are associated with improved patient outcomes.
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Affiliation(s)
- Juan P Wisnivesky
- Department of Medicine, Icahn School of Medicine at Mount Sinai, New York, NY.
| | - Rex Chin-Wei Yung
- Division of Pulmonary Medicine and Critical Care Medicine, Johns Hopkins University, Baltimore, MD
| | - Praveen N Mathur
- Division of Pulmonary, Critical Care, Allergy and Occupational Medicine, Department of Medicine, Indiana University Medical Center, Indianapolis, IN
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Daniels JMA, Sutedja TG. Detection and minimally invasive treatment of early squamous lung cancer. Ther Adv Med Oncol 2013; 5:235-48. [PMID: 23858332 DOI: 10.1177/1758834013482345] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2023] Open
Abstract
Non-small cell lung cancer (NSCLC) is the most common cause of cancer deaths worldwide. The majority of patents presenting with NSCLC have advanced disease, which precludes curative treatment. Early detection and treatment might result in the identification of more patients with early central lung cancer and improve survival. In addition, the study of early lung cancer improves understanding of lung carcinogenesis and might also reveal new treatment targets for advanced lung cancer. Bronchoscopic investigation of the central airways can reveal both early central lung cancer in situ (stage 0) and other preinvasive lesions such as dysplasia. In the current review we discuss the detection of early squamous lung cancer, the natural history of preinvasive lesions and whether biomarkers can be used to predict progression to cancer. Finally we will review the staging and management of preinvasive lung cancer lesions and the different therapeutic modalities that are available.
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Affiliation(s)
- Johannes M A Daniels
- Department of Pulmonary Diseases, Z 4A48, VU University Medical Center, De Boelelaan 1117, 1081HV Amsterdam, The Netherlands
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von Breitenbuch P, Jeiter T, Schreml S, Glockzin G, Agha A, Piso P, Schlitt HJ. Autofluorescent imaging in patients with peritoneal carcinomatosis. Surg Innov 2013; 21:187-93. [PMID: 23843158 DOI: 10.1177/1553350613495114] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/27/2023]
Abstract
BACKGROUND AND OBJECTIVES Autofluorescence imaging (AFI) is mainly used to detect (pre)cancerous colorectal and pulmonal lesions. This is the first report establishing the feasibility of AFI in patients with peritoneal carcinomatosis (PC). METHODS This is a prospective analysis of 10 patients undergoing conventional white-light laparoscopy (WL) and AFI for PC of different gastrointestinal tumors and 1 ovarian cancer. Before taking biopsies, suspicious peritoneal lesions were first detected by WL and then investigated by AFI. The intraoperative findings were photographed and then correlated with histological results. RESULTS Conventional WL and AFI evaluation was successful in all patients. A total of 38 biopsies were taken. The neoplasm detection rate under WL was 66% and increased to 86% when using AFI. The positive tumor detection rate was slightly higher in low AF lesions (83 vs 88%) and higher in tumor nodules (94%) than in flat peritoneal lesions (75%). For tumor nodules, the sensitivity was 94%, and the specificity was 100%. For flat lesions, the sensitivity was 75% and specificity 50%. CONCLUSIONS We demonstrate the feasibility and effectiveness of AFI in patients with PC.
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Abstract
Early detection and surgical resection are essential for the treatment of lung cancer. It would be ideal to be able to detect and treat preinvasive bronchial lesions, defined as dysplasia and carcinoma in situ before progressing to invasive cancer. Advanced airway-assessment techniques have opened an avenue for early detection and surveillance of endobronchial malignancy. This article reviews currently available advanced imaging techniques for early detection of lung cancer, including autofluorescence bronchoscopy, narrow-band imaging, high-magnification bronchovideoscopy, endobronchial ultrasonography, and optical coherence tomography. Also discussed are the more recently developed endocytoscopy system and confocal fluorescence microendoscopy, currently used only for research purposes.
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Affiliation(s)
- Takahiro Nakajima
- Division of Thoracic Surgery, Toronto General Hospital, University Health Network, University of Toronto, 200 Elizabeth Street, 9N-957, Toronto, Ontario M5G 2C4, Canada
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Zaric B, Perin B, Carapic V, Stojsic V, Matijasevic J, Andrijevic I, Kopitovic I. Diagnostic value of autofluorescence bronchoscopy in lung cancer. Thorac Cancer 2013; 4:1-8. [PMID: 28920319 DOI: 10.1111/j.1759-7714.2012.00130.x] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022] Open
Abstract
The role of autofluorescence bronchoscopy (AFB) was primarily investigated in regard to the detection of precancerous lesions of bronchial mucosa. Most of the results confirmed higher sensitivity for the detection of precancerous bronchial lesions, when compared to white light bronchoscopy (WLB) alone. However, it is commonly known that the specificity of AFB remains low. Our findings agree in terms of the detection of premalignant bronchial lesions and early lung cancer, but regarding the detection of synchronous lesions or in the evaluation of lung cancer extension, the specificity of AFB is significantly higher. There is still an ongoing debate in the scientific community whether or not autofluorescence should be used as a screening tool for lung cancer. Results of the majority of published series did not support the general use of AFB as a screening tool for lung cancer; however, these results suggest its use in groups of patients with a high risk of lung cancer. Despite this, some authors still do not recommend its use even in high-risk cases. In recent years, the indications for AFB have been widening and this tool may find its place in routine bronchoscopy. With new indications for AFB, such as the evaluation of tumor extension or follow up after surgical resection, bronchoscopists may make use of this tool more often. A sharp learning curve and a clear distinction between healthy and pathologically altered mucosa make this technology acceptable for inexperienced bronchoscopists. We also investigate new hardware and software improvements in AFB. The addition of backscattered light analysis, ultraviolet spectra, fluorescence-reflectance or dual digital systems could improve the diagnostic yield of this technology.
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Affiliation(s)
- Bojan Zaric
- Institute for Pulmonary Diseases of Vojvodina, Clinic for Pulmonary Oncology, Faculty of Medicine, University of Novi Sad, Sremska Kamenica, Vojvodina, SerbiaInstitute for Pulmonary Diseases of Vojvodina, Clinic for Urgent Pulmology, Faculty of Medicine, University of Novi Sad, Sremska Kamenica, Vojvodina, Serbia
| | - Branislav Perin
- Institute for Pulmonary Diseases of Vojvodina, Clinic for Pulmonary Oncology, Faculty of Medicine, University of Novi Sad, Sremska Kamenica, Vojvodina, SerbiaInstitute for Pulmonary Diseases of Vojvodina, Clinic for Urgent Pulmology, Faculty of Medicine, University of Novi Sad, Sremska Kamenica, Vojvodina, Serbia
| | - Vladimir Carapic
- Institute for Pulmonary Diseases of Vojvodina, Clinic for Pulmonary Oncology, Faculty of Medicine, University of Novi Sad, Sremska Kamenica, Vojvodina, SerbiaInstitute for Pulmonary Diseases of Vojvodina, Clinic for Urgent Pulmology, Faculty of Medicine, University of Novi Sad, Sremska Kamenica, Vojvodina, Serbia
| | - Vladimir Stojsic
- Institute for Pulmonary Diseases of Vojvodina, Clinic for Pulmonary Oncology, Faculty of Medicine, University of Novi Sad, Sremska Kamenica, Vojvodina, SerbiaInstitute for Pulmonary Diseases of Vojvodina, Clinic for Urgent Pulmology, Faculty of Medicine, University of Novi Sad, Sremska Kamenica, Vojvodina, Serbia
| | - Jovan Matijasevic
- Institute for Pulmonary Diseases of Vojvodina, Clinic for Pulmonary Oncology, Faculty of Medicine, University of Novi Sad, Sremska Kamenica, Vojvodina, SerbiaInstitute for Pulmonary Diseases of Vojvodina, Clinic for Urgent Pulmology, Faculty of Medicine, University of Novi Sad, Sremska Kamenica, Vojvodina, Serbia
| | - Ilija Andrijevic
- Institute for Pulmonary Diseases of Vojvodina, Clinic for Pulmonary Oncology, Faculty of Medicine, University of Novi Sad, Sremska Kamenica, Vojvodina, SerbiaInstitute for Pulmonary Diseases of Vojvodina, Clinic for Urgent Pulmology, Faculty of Medicine, University of Novi Sad, Sremska Kamenica, Vojvodina, Serbia
| | - Ivan Kopitovic
- Institute for Pulmonary Diseases of Vojvodina, Clinic for Pulmonary Oncology, Faculty of Medicine, University of Novi Sad, Sremska Kamenica, Vojvodina, SerbiaInstitute for Pulmonary Diseases of Vojvodina, Clinic for Urgent Pulmology, Faculty of Medicine, University of Novi Sad, Sremska Kamenica, Vojvodina, Serbia
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Ikeda N, Usuda J, Kato H, Ishizumi T, Ichinose S, Otani K, Honda H, Furukawa K, Okunaka T, Tsutsui H. New aspects of photodynamic therapy for central type early stage lung cancer. Lasers Surg Med 2012; 43:749-54. [PMID: 22057502 DOI: 10.1002/lsm.21091] [Citation(s) in RCA: 47] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
BACKGROUND and Objective Photodynamic therapy (PDT) has come to be considered as the first choice of treatment for central type early stage lung cancer (CELC). Recent advances in the ability to diagnose CELC, and in photosensitizers, as well as sophisticated clinical management, may improve the therapeutic outcome and expand the indications of PDT. MATERIALS AND METHODS We made the search for papers on PDT for lung cancer to select the most relevant articles. Based on this review and our recent data, we discussed the best available evidence for the diagnosis, the definition of indications, photosensitizers, and clinical management with regard to PDT. RESULTS To obtain complete response (CR) by PDT, the selection of the indications is extremely important, including the extent of the tumor on the bronchial surface and the depth of invasion in the bronchial wall. The development of autofluorescence bronchoscopy (AFB) and endobronchial ultrasonography (EBUS) have had a large impact on diagnostic bronchoscopy for CELC. CELCs less than 1 cm in diameter showed a favorable cure rate by PDT, thus this is a good indication for PDT. The relatively newer photosensitizer NPe6, which has a stronger antitumor effect than Photofrin, showed similar treatment outcome even for large tumors >1.0 cm in diameter. Furthermore, comprehensive management including photodynamic diagnosis before and after PDT should be effective to minimize the possibility of local recurrence after PDT. CONCLUSION The present guidelines of PDT for CELC were established based on the data obtained from studies in the 1980's. We postulate that comprehensive diagnosis and the new generation of photosensitizers may increase the CR rate and expand the indications of PDT for larger tumors.
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Affiliation(s)
- Norihiko Ikeda
- Department of Surgery, Tokyo Medical University, Tokyo, Japan.
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van der Leest C, Amelink A, van Klaveren RJ, Hoogsteden HC, Sterenborg HJCM, Aerts JGJV. Optical detection of preneoplastic lesions of the central airways. ISRN ONCOLOGY 2012; 2012:957835. [PMID: 22550600 PMCID: PMC3324886 DOI: 10.5402/2012/957835] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 12/27/2011] [Accepted: 01/16/2012] [Indexed: 01/01/2023]
Abstract
Current routine diagnosis of premalignant lesions of the central airways is hampered due to a limited sensitivity (white light bronchoscopy) and resolution (computer tomography (CT), positron emission tomography (PET)) of currently used techniques. To improve the detection of these subtle mucosal abnormalities, novel optical imaging bronchoscopic techniques have been developed over the past decade. In this review we highlight the technological developments in the field of endoscopic imaging, and describe their advantages and disadvantages in clinical use.
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Affiliation(s)
- C van der Leest
- Department of Respiratory Diseases, Erasmus Medical Center, Postbus 2040, 3000 CA Rotterdam, The Netherlands
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18
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Chen W, Gao X, Tian Q, Chen L. A comparison of autofluorescence bronchoscopy and white light bronchoscopy in detection of lung cancer and preneoplastic lesions: A meta-analysis. Lung Cancer 2011; 73:183-8. [DOI: 10.1016/j.lungcan.2010.12.002] [Citation(s) in RCA: 49] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2010] [Revised: 11/25/2010] [Accepted: 12/03/2010] [Indexed: 11/15/2022]
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The Value of Autofluorescence Bronchoscopy Combined with White Light Bronchoscopy Compared with White Light Alone in the Diagnosis of Intraepithelial Neoplasia and Invasive Lung Cancer: A Meta-Analysis. J Thorac Oncol 2011; 6:1336-44. [DOI: 10.1097/jto.0b013e318220c984] [Citation(s) in RCA: 61] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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20
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Zaric B, Perin B, Becker HD, Herth FFJF, Eberhardt R, Djuric M, Djuric D, Matijasevic J, Kopitovic I, Stanic J. Autofluorescence imaging videobronchoscopy in the detection of lung cancer: from research tool to everyday procedure. Expert Rev Med Devices 2011; 8:167-72. [PMID: 21395470 DOI: 10.1586/erd.10.92] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
Autofluorescence imaging videobronchoscopy (AFI) is one of the new systems of autofluorescence bronchoscopy designed for thorough examination of bronchial mucosa. The integration of autofluorescence and videobronchoscopy provides clear images of normal and pathologically altered bronchial mucosa. Major indications for AFI include evaluation of early-stage lung cancer and detection of precancerous lesions. However, in recent years, the indications for AFI are widening, and this tool might find its place in routine daily bronchoscopic practice. With new indications for AFI, such as evaluation of tumor extension or follow-up after surgical resection, this tool might be more often used by bronchoscopists. A sharp learning curve and clear distinction between healthy and pathologically altered mucosa make this technology acceptable for young and inexperienced bronchoscopists. One of the major disadvantages of AFI is low specificity in the detection of premalignant lesions and early-stage lung cancer. This disadvantage could be overcome with the appearance of new and improved technologies in autofluorescence, such as the addition of backscattered light analysis, ultraviolet spectra, fluorescence-reflectance or dual digital systems. Quantitative image analysis is also one of the ways to improve objectivity and minimize observer errors. However, one of the most appropriate solutions would be the addition of AFI to narrow band imaging, and merging the two technologies into one videobronchoscope.
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Affiliation(s)
- Bojan Zaric
- Institute for Pulmonary Diseases of Vojvodina, Clinic for Pulmonary Oncology, Faculty of Medicine, University of Novi Sad, Serbia.
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Alaa RM M, Shibuya K, Fujiwara T, Wada H, Hoshino H, Yoshida S, Suzuki M, Hiroshima K, Nakatani Y, Mohamed-Hussein AA, Elkholy MM, Mahfouz T, Yoshino I. Risk of lung cancer in patients with preinvasive bronchial lesions followed by autofluorescence bronchoscopy and chest computed tomography. Lung Cancer 2011; 72:303-8. [DOI: 10.1016/j.lungcan.2010.09.014] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2010] [Revised: 09/20/2010] [Accepted: 09/28/2010] [Indexed: 10/18/2022]
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Yarmus L, Feller-Kopman D. Bronchoscopes of the twenty-first century. Clin Chest Med 2010; 31:19-27, Table of Contents. [PMID: 20172429 DOI: 10.1016/j.ccm.2009.11.002] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
Over the past century, bronchoscopy has become an essential tool for pulmonologists and thoracic surgeons, who for many years have employed bronchoscopy with such therapeutic modalities as laser therapy, electrocautery, cryotherapy, and stent placement. Over the past decade, advanced imaging techniques, such as autofluoresence bronchoscopy, electromagnetic navigation, narrow-band imaging, confocal fluorescence microendoscopy, and endobronchial ultrasound, have greatly expanded the diagnostic utility of bronchoscopy. This article reviews the technological advances in the field of diagnostic bronchoscopy.
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Affiliation(s)
- Lonny Yarmus
- Interventional Pulmonology, Division of Pulmonary and Critical Care, The Johns Hopkins Hospital, 1830 East Monument Street, 5th Floor, Baltimore, MD 21205, USA
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23
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Abstract
Diagnostic bronchoscopy has undergone two major paradigm shifts in the last 40 years. First, the advent of flexible bronchoscopy gave chest physicians improved access to the tracheobronchial tree with a rapid learning curve and greater patient comfort compared with rigid bronchoscopy. The second paradigm shift has evolved over the last 5 years with the proliferation of new technologies that have significantly enhanced the diagnostic capabilities of flexible bronchoscopy compared with traditional methods. At the forefront of these new technologies is endobronchial ultrasound. In its various forms, endobronchial ultrasound has improved diagnostic yield for pulmonary masses, nodules, intrathoracic adenopathy, and disease extent, thereby reducing the need for more invasive surgical interventions. Various navigational bronchoscopy systems have become available to increase flexible bronchoscope access to small peripheral pulmonary lesions. Furthermore, various modalities of airway assessment, including optical microscopic imaging technologies, may play significant roles in the diagnosis of a variety of pulmonary diseases in the future. Finally, the combination of new diagnostic bronchoscopy technologies and novel approaches in molecular analysis and biomarker assessment hold promise for enhanced diagnosis and personalized management of many pulmonary disorders. In this review, we provide a contemporary review of diagnostic bronchoscopy developments over the past decade.
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Affiliation(s)
- Andrew R Haas
- Clinical Operations, Interventional Pulmonology and Thoracic Oncology, Pulmonary, Allergy, and Critical Care Division, University of Pennsylvania Medical Center, 3600 Spruce Street, Philadelphia, PA 19104-4283, USA.
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25
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Gesierich W. Diagnostic and therapeutic laser applications in pulmonary medicine – A review. ACTA ACUST UNITED AC 2010. [DOI: 10.1016/j.mla.2009.11.002] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
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Yarmus L, Ernst A, Feller-Kopman D. Emerging technologies for the thorax: indications, management and complications. Respirology 2009; 15:208-19. [PMID: 20051044 DOI: 10.1111/j.1440-1843.2009.01680.x] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
The field of interventional pulmonology has rapidly expanded to include the management and treatment of complex diseases of the chest. The management of central airway obstruction, pleural disease diagnosis, treatment and palliation, advanced bronchoscopic techniques to aid in the diagnosis of lung cancer and innovative therapies to treat asthma and COPD have all emerged over the past decade. As astute clinicians, we are all aware of the risks and benefits of using these therapies to treat our patients. In order to appropriately treat and manage these often complex medical situations, the physician should have an expert knowledge of all available modalities, the expertise to safely perform the procedure and the ability to minimize the risk of and manage the associated complications that may arise. In this chapter we review and update some of the bronchoscopic and pleural interventions offered by interventional pulmonologists as well as the associated complications and management.
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Affiliation(s)
- Lonny Yarmus
- Division of Interventional Pulmonology, The Johns Hopkins Hospital, Baltimore, Maryland 21205, USA
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Current indications and future perspective of fluorescence bronchoscopy: A review study. Photodiagnosis Photodyn Ther 2008; 5:238-46. [DOI: 10.1016/j.pdpdt.2009.01.008] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2008] [Revised: 01/27/2009] [Accepted: 01/27/2009] [Indexed: 11/20/2022]
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Automated detection of genetic abnormalities combined with cytology in sputum is a sensitive predictor of lung cancer. Mod Pathol 2008; 21:950-60. [PMID: 18500269 PMCID: PMC3377448 DOI: 10.1038/modpathol.2008.71] [Citation(s) in RCA: 42] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2023]
Abstract
Detection of lung cancer by sputum cytology has low sensitivity but is noninvasive and, if improved, could be a powerful tool for early lung cancer detection. To evaluate whether the accuracy of diagnosing lung cancer by evaluating sputa for cytologic atypia and genetic abnormalities is greater than that of conventional cytology alone, automated scoring of genetic abnormalities for 3p22.1 and 10q22.3 (SP-A) by fluorescence in situ hybridization (FISH) and conventional cytology was done on sputa from 35 subjects with lung cancer, 25 high-risk smokers, and 6 healthy control subjects. Multivariate analysis was performed to select variables that most accurately predicted lung cancer. A model of probability for the presence of lung cancer was derived for each subject. Cells exfoliated from patients with lung cancer contained genetic aberrations and cytologic atypias at significantly higher levels than in those from control subjects. When combined with cytologic atypia, a model of risk for lung cancer was derived that had 74% sensitivity and 82% specificity to predict the presence of lung cancer, whereas conventional cytology achieved only 37% sensitivity and 87% specificity. For diagnosing lung cancer in sputum, a combination of molecular and cytologic variables was superior to using conventional cytology alone.
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Autofluorescence Bronchoscopy to Detect Bronchial Epithelial Changes Associated With Cigarette Smoking Among Asymptomatic Volunteers: A Single Center Prospective Pilot Study. ACTA ACUST UNITED AC 2008. [DOI: 10.1097/lbr.0b013e3181641b5f] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Gabrecht T, Radu A, Zellweger M, Lovisa B, Goujon D, Grosjean P, van den Bergh H, Monnier P, Wagnières G. Autofluorescence bronchoscopy: Clinical experience with an optimized system in head and neck cancer patients. ACTA ACUST UNITED AC 2007. [DOI: 10.1016/j.mla.2007.09.003] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
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Lee P, Brokx HAP, Postmus PE, Sutedja TG. Dual digital video-autofluorescence imaging for detection of pre-neoplastic lesions. Lung Cancer 2007; 58:44-9. [PMID: 17532537 DOI: 10.1016/j.lungcan.2007.04.009] [Citation(s) in RCA: 38] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2006] [Revised: 04/11/2007] [Accepted: 04/17/2007] [Indexed: 12/31/2022]
Abstract
AIM The incorporation of autofluorescence (AF) to white light bronchoscopy has led to improved sensitivity for the detection of pre-neoplastic lesions in the airways. However, AF has difficulty distinguishing benign epithelial changes such as bronchitis, previous biopsy, and airway fibrosis from pre-invasive lesions, which necessitates extensive biopsy. This frequently results in longer procedural time and need for additional sedation that may compromise patient safety, increase the risk of bronchospasm, and bleeding from multiple endobronchial biopsies. We postulate that dual imaging with simultaneous video and AF bronchoscopy of the tracheobronchial tree could improve the low specificity observed with AF in the detection of pre-invasive lesions, leading to targeted biopsy, good correlation with pathological diagnosis and shorter procedural time. METHODS Forty-eight patients with known or suspected of lung cancer underwent video and AF bronchoscopy, which were provided as real-time dual images with SAFE 3000 (Pentax, Tokyo) between March and August 2006. Biopsy specimens were taken from all suspicious areas with two random specimens from normal areas. Values were expressed as median and range, and p<0.05 was considered statistically significant. RESULTS Twenty-five suspicious sites were detected by dual imaging bronchoscopy, and 126 endobronchial biopsies were evaluated, of which 22 (17.5%) were graded as moderate dysplasia and worse. Sensitivity and specificity of dual imaging for the detection of high-grade dysplasia were 86% and 94%, respectively, with good correlation between bronchoscopic assessment and pathology (r=0.77, p<0.0001). However, there were three random biopsy specimens obtained from normal or abnormal sites that showed severe dysplasia in two and moderate dysplasia in one. Median time taken for airway examination was 4 min (range, 4-4.8), and 5 min (range, 4-5) for biopsy, giving a total procedural time of 9 min (range, 8-10). There were no procedure-related complications noted. CONCLUSION Dual imaging that allows simultaneous real-time assessment of the lesion with video and AF bronchoscopy not only achieves satisfactory sensitivity for the detection of pre-neoplastic lesions, importantly it improves specificity by allowing targeted biopsy, which has led to a marked decrease in procedural time and better patient safety.
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Affiliation(s)
- Pyng Lee
- Department of Pulmonary Diseases, VU University Medical Centre, Amsterdam, The Netherlands.
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32
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Kennedy TC, McWilliams A, Edell E, Sutedja T, Downie G, Yung R, Gazdar A, Mathur PN. Bronchial Intraepithelial Neoplasia/Early Central Airways Lung Cancer. Chest 2007; 132:221S-233S. [PMID: 17873170 DOI: 10.1378/chest.07-1377] [Citation(s) in RCA: 80] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/29/2023] Open
Abstract
BACKGROUND An evidence-based approach is necessary for the localization and management of intraepithelial and microinvasive non-small cell lung cancer in the central airways. METHODS Material appropriate to this topic was obtained by literature search of a computerized database. Recommendations were developed by the writing committee and then reviewed by the entire guidelines panel. The final recommendations were made by the Chair and were voted on by the entire committee. RESULTS White light bronchoscopy has diagnostic limitations in the detection of microinvasive lesions. Autofluorescence bronchoscopy (AFB) is a technique that has been shown to be a sensitive method for detecting these lesions. In patients with moderate dysplasia or worse on sputum cytology and normal chest radiographic findings, bronchoscopy should be performed. If moderate/severe dysplasia or carcinoma in situ (CIS) is detected in the central airways, then bronchoscopic surveillance is recommended. The use of AFB is preferred if available. In a patient being considered for curative endobronchial therapy to treat microinvasive lesions, AFB is useful. A number of endobronchial techniques as therapeutic options are available for the management of CIS and can be recommended to patients with inoperable disease. In patients with operable disease, surgery remains the mainstay of treatment, although patients may be counseled about these techniques. CONCLUSIONS AFB is a useful tool for the localization of microinvasive neoplasia. A number of endobronchial techniques available for the curative treatment can be considered first-line therapy in inoperable cases. For operable cases, the techniques may be considered and discussed with the patients.
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Affiliation(s)
- Timothy C Kennedy
- MBBS, 550 W University Blvd, Suite 4903, Indianapolis IN 46202, USA.
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Ikeda N, Hayashi A, Iwasaki K, Honda H, Tsuboi M, Usuda J, Kato H. Comprehensive diagnostic bronchoscopy of central type early stage lung cancer. Lung Cancer 2007; 56:295-302. [PMID: 17291623 DOI: 10.1016/j.lungcan.2007.01.009] [Citation(s) in RCA: 28] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2006] [Revised: 01/04/2007] [Accepted: 01/05/2007] [Indexed: 10/23/2022]
Abstract
Due to advances in interventional bronchoscopy, curative treatment has become possible for central type lung cancer if it is detected in the early stage. However, expertise is required to diagnose the extent of tumor invasion and the depth of tumor involvement by conventional white light bronchoscopy alone, but judgement is still subjective. The development of autofluorescence bronchoscopy (AFB) and endobronchial ultrasonography (EBUS) has had a large impact on diagnostic bronchoscopy in the past decade and have been employed especially for the diagnosis of central type tumors. Objective evaluation by a comprehensive approach using AFB, EBUS and optical coherence tomography (OCT) enables selection of the optimal therapeutic strategy for central type early lung cancer (CELC).
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Affiliation(s)
- Norihiko Ikeda
- Department of Thoracic Oncology and Surgery, International University of Health and Welfare, Mita Hospital, Japan.
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Herth FJF, Eberhardt R, Ernst A. The future of bronchoscopy in diagnosing, staging and treatment of lung cancer. Respiration 2006; 73:399-409. [PMID: 16775411 DOI: 10.1159/000093369] [Citation(s) in RCA: 44] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022] Open
Abstract
Bronchoscopy is a central technique in diagnosing lung cancer, but also in different therapeutic approaches. A lot of techniques are available. The most common indication for bronchoscopy is for tissue sampling and determining the extent of lung cancer. Established diagnostic techniques are forceps biopsy, aspiration or brush cytology sampling, or needle aspiration. Laser therapy, electrocautery, cryotherapy and stenting are well-described techniques for the palliation of symptoms due to airway involvement in patients with advanced stages. Newer technologies, with an established role in clinical practice, are endobronchial ultrasound, autofluorescence bronchoscopy, and electromagnetic navigation. Other technologies, such as magnification, narrow-band imaging and confocal fluorescence microendoscopy, are in development for the use within the airways.
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Affiliation(s)
- Felix J F Herth
- Department of Pneumology and Critical Care Medicine, Thoraxklinik, University of Heidelberg, Heidelberg, Germany.
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Sekine Y, Saitoh Y, Chiyo M, Yasufuku K, Iyoda A, Shibuya K, Iizasa T, Fujisawa T. Characteristics of Tumor Extension Requiring Bronchoplasty and Pneumonectomy in Patients with Lung Cancer and Positive Bronchoscopic Findings. Surg Today 2006; 36:491-8. [PMID: 16715416 DOI: 10.1007/s00595-006-3190-0] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2005] [Accepted: 11/15/2005] [Indexed: 11/24/2022]
Abstract
PURPOSE The characteristics of tumor extension determine whether pneumonectomy or lobectomy with bronchoplasty should be performed for central lung cancer. We investigated how the characteristics of tumor extension determined the operative methods and the surgical outcomes. METHODS We conducted a retrospective chart review of 151 patients with positive bronchoscopic findings who underwent lung cancer operations between January 1995 and March 2002. Twenty-five patients underwent pneumonectomy, 88 underwent lobectomy/segmentectomy (Lob/Seg), and 38 underwent Lob/Seg with bronchoplasty. RESULTS Pathologic staging was higher in the pneumonectomy group than in the Lob/Seg groups, with or without bronchoplasty (P = 0.002). Interlobar extension and hilar lymph node involvement were more frequent, and mucosal invasion was less frequent, in the pneumonectomy group than in the Lob/Seg with bronchoplasty group. The frequencies of all specific pulmonary complications and 30-day mortality were similar among the three groups. The 5-year overall survival rates were 23.7%, 51.5%, and 72.8% for the pneumonectomy, Lob/Seg, and Lob/Seg with bronchoplasty groups, respectively (P = 0.0004). There was a significant difference in survival between patients with mucosal and those with submucosal types of lung cancer (P = 0.0114). CONCLUSIONS Lob/Seg with bronchoplasty was feasible without a higher risk of operative complications or poorer long-term survival. The nature of tumor extension was important in the selection of operative methods and in predicting survival.
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Affiliation(s)
- Yasuo Sekine
- Department of Thoracic Surgery, Graduate School of Medicine, Chiba University, 1-8-1 Inohana, Chuo-ku, Chiba, 260-8670, Japan
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Abstract
In the USA, lung cancer is the leading cause of cancer death. Earlier studies of CXR and sputum cytology screening conducted in the 1970s showed no mortality benefit. Accordingly, mass screening for lung cancer was abandoned and is not currently recommended. Recently, interest in lung cancer screening has been revived due to various reports showing an advantage of low-dose CT over CXR in detecting smaller size tumours and at an earlier stage. Although these reports generated much enthusiasm for screening among clinicians and the general public, the effectiveness of low-dose CT in reducing lung cancer-specific mortality rates has not been demonstrated. Large-scale randomized controlled trials are currently in progress to determine the efficacy of CXR and low-dose CT screening. This review highlights the advantages and limitations of current modalities for lung cancer screening. The cases for and against screening with currently available modalities are examined. Additional new screening modalities are also discussed.
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Affiliation(s)
- Vasken Artinian
- Henry Ford Hospital, Division of Pulmonary and Critical Care, Detroit, MI 48202, USA
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Chiyo M, Shibuya K, Hoshino H, Yasufuku K, Sekine Y, Iizasa T, Hiroshima K, Fujisawa T. Effective detection of bronchial preinvasive lesions by a new autofluorescence imaging bronchovideoscope system. Lung Cancer 2005; 48:307-13. [PMID: 15892998 DOI: 10.1016/j.lungcan.2004.11.023] [Citation(s) in RCA: 55] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2004] [Revised: 11/17/2004] [Accepted: 11/23/2004] [Indexed: 01/31/2023]
Abstract
Autofluorescence bronchoscopy is an important tool for the early detection of preinvasive bronchial lesions. However, autofluorescence bronchoscopy has difficulty distinguishing between preinvasive lesions and other benign epithelial changes. A new autofluorescence imaging bronchovideoscope system (AFI) comprises three signals, including an autofluorescence (460-690 nm) on excitation blue light (395-445 nm) and two different bands of reflected light: G' (550 nm) and R' (610 nm). We hypothesized that color analyses of these three wave lengths would improve our ability to differentiate between inflammation and preinvasive lesions. In order to prove this hypothesis and to evaluate the efficacy of AFI for detecting preinvasive lesions, we conducted a prospective study. A total of 32 patients with suspected or known lung cancer were entered into this study. Conventional white light bronchovideoscopy (WLB) and light induced fluorescence endoscopy (LIFE) were performed prior to using AFI. WLB and LIFE detected 62 lesions, including lung cancers (n=2), squamous dysplasias (n=30), and bronchitis (n=30). By utilizing AFI, 24 dysplasias and 2 cancer lesions were magenta in color, while 25 bronchitis lesions were blue. The sensitivities of detecting dysplasia by LIFE and AFI were 96.7% and 80%, respectively. The specificity of AFI (83.3%) was significantly higher than that of LIFE (36.6%) (p=0.0005). We conclude that AFI appears to represent a significant advance in distinguishing preinvasive and malignant lesions from bronchitis or hyperplasia under circumstances where LIFE would identify these all as abnormal lesions.
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Affiliation(s)
- Masako Chiyo
- Department of Thoracic Surgery, Graduate School of Medicine, Chiba University, 1-8-1 Inohana, Chuo-ku, Chiba 260-8670, Japan
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Häussinger K, Becker H, Stanzel F, Kreuzer A, Schmidt B, Strausz J, Cavaliere S, Herth F, Kohlhäufl M, Müller KM, Huber RM, Pichlmeier U, Bolliger CT. Autofluorescence bronchoscopy with white light bronchoscopy compared with white light bronchoscopy alone for the detection of precancerous lesions: a European randomised controlled multicentre trial. Thorax 2005; 60:496-503. [PMID: 15923251 PMCID: PMC1747416 DOI: 10.1136/thx.2005.041475] [Citation(s) in RCA: 129] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
BACKGROUND The potential of autofluorescence bronchoscopy (AFB) to detect precancerous lesions in the central airways and its role in lung cancer screening is uncertain. A study was undertaken to evaluate the prevalence of moderate/severe dysplasia (dysplasia II-III) and carcinoma in situ (CIS) using a newly developed AFB system in comparison with conventional white light bronchoscopy (WLB) alone. METHODS In a prospective randomised multicentre trial, smokers > or = 40 years of age (> or = 20 pack-years) were stratified into four different risk groups and investigated with either WLB+AFB (arm A) or WLB alone (arm B). RESULTS 1173 patients (916 men) of mean age 58.7 years were included. Overall (arms A and B), preinvasive lesions (dysplasia II-III and CIS) were detected in 3.9% of the patients. The prevalence of patients with preinvasive lesions in the WLB arm was 2.7% compared with 5.1% in the WLB+AFB arm (p = 0.037). For patients with dysplasia II-III, WLB+AFB increased the detection rate by a factor of 2.1 (p = 0.03), while for CIS the factor was only 1.24 (p = 0.75). The biopsy based sensitivity of WLB alone and WLB+AFB for detecting dysplasia II-III and CIS was 57.9% compared with 82.3% (1.42-fold increase). The corresponding specificity was 62.1% compared with 58.4% (0.94-fold decrease). CONCLUSIONS This first randomised study of AFB showed that the combination of WLB+AFB was significantly superior to WLB alone in detecting preneoplastic lesions. Our findings do not support the general use of AFB as a screening tool for lung cancer, but suggest that it may be of use in certain groups. The precise indications await further study.
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Affiliation(s)
- K Häussinger
- Center for Respiratory Medicine and Thoracic Surgery, Asklepios Fachkliniken München-Gauting, Robert-Koch-Allee 2, D-82131 Gauting, Germany.
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Hoshino H, Shibuya K, Chiyo M, Iyoda A, Yoshida S, Sekine Y, Iizasa T, Saitoh Y, Baba M, Hiroshima K, Ohwada H, Fujisawa T. Biological features of bronchial squamous dysplasia followed up by autofluorescence bronchoscopy. Lung Cancer 2004; 46:187-96. [PMID: 15474667 DOI: 10.1016/j.lungcan.2004.04.028] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/30/2003] [Revised: 03/31/2004] [Accepted: 04/15/2004] [Indexed: 10/26/2022]
Abstract
Some dysplasias in the bronchial epithelium are thought to be precancerous lesions that can develop into squamous cell carcinomas. In this investigation, we assessed the biological behavior of bronchial squamous dysplasia in order to define which dysplasias have the potential to progress to squamous cell carcinoma. Using autofluorescence bronchoscopy, we followed up periodically localized dysplasias and examined for correlation between histological outcome and smoking status during the follow-up period, telomerase activity, Ki-67 labeling index, and p53 immunoreactivity of initial biopsy specimens. Ninety-nine dysplasias from 50 participants mainly with sputum cytology suspicious or positive for malignancy were followed up. Of 99 dysplasias, 3 dysplasias progressed to squamous cell carcinoma, 41 dysplasias remained as dysplasia, 6 dysplasias changed to metaplasia, 14 dysplasias changed to hyperplasia, and 35 dysplasias regressed to bronchitis or normal bronchial epithelium. There were no significant associations between histological outcome and smoking status. Mean initial telomerase activity and Ki-67 labeling index values in the dysplasias increased in proportion to the severity of the histological outcome at the second biopsy. There was also a significant difference between p53-positive and p53-negative dysplasia in terms of histological outcome at the second biopsy. Our results suggested that dysplasias with high telomerase activity, increased Ki-67 labeling index, and p53-positivity tended to remain as dysplasia and might have the potential to progress to squamous cell carcinoma. Patients with dysplastic lesions with these characteristics should be carefully followed up.
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Affiliation(s)
- Hidehisa Hoshino
- Department of Thoracic Surgery, Graduate School of Medicine, Chiba University, 1-8-1 Inohana, Chuo-ku, Chiba 260-8670, Japan.
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Abstract
Detection of clinically occult lung neoplasms may represent an opportunity for early curative intervention. Fluorescent bronchoscopy is a sensitive technique for detecting early endobronchial tumors that may be combined with CT scanning as part of a comprehensive lung cancer screening program. Identification and longitudinal follow-up of dysplastic endobronchial changes with fluorescent bronchoscopy should facilitate studies of chemoprevention and further knowledge regarding the natural history of these lesions. Analysis of bronchial epithelium with novel techniques such as genomic hybridization and gene expression arrays might provide even better predictors of progression of dysplastic endobronchial lesions.
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Affiliation(s)
- Sebastien Gilbert
- Division of Thoracic and Foregut Surgery, University of Pittsburgh Medical Center, 200 Lothrop Street, Suite C800, Pittsburgh, PA 15213, USA
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Zeng H, McWilliams A, Lam S. Optical spectroscopy and imaging for early lung cancer detection: a review. Photodiagnosis Photodyn Ther 2004; 1:111-22. [DOI: 10.1016/s1572-1000(04)00042-0] [Citation(s) in RCA: 43] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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Abstract
The majority of early lesions, even when centrally located, is missed by conventional white-light (WL) bronchoscopy. Fluorescent bronchoscopy is a promising tool in localising early malignant changes in the central airways, because it is significantly more sensitive than WL bronchoscopy. Originally, drug-induced fluorescence has been used, but today autofluorescence bronchoscopy is more common in relation to its simplicity and advantages. Different systems are available which yield comparable results. However, there are no studies comparing all systems. The disadvantage is the low specificity of the method. Fluorescent bronchoscopy will be more effective if carried out in high-risk patients and/or embedded in a program of preprocedural evaluation of sputum and together with a CT examination of the thorax. But a reduction of mortality as a result of such efforts has not been shown until the present time.
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Affiliation(s)
- Franz Stanzel
- Asklepios Fachkliniken Munich-Gauting, Clinic for Pneumology, Robert-Koch-Allee 2, D-82131 Gauting, Germany.
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Yasufuku K, Chiyo M, Sekine Y, Chhajed PN, Shibuya K, Iizasa T, Fujisawa T. Real-time Endobronchial Ultrasound-Guided Transbronchial Needle Aspiration of Mediastinal and Hilar Lymph Nodes. Chest 2004; 126:122-8. [PMID: 15249452 DOI: 10.1378/chest.126.1.122] [Citation(s) in RCA: 434] [Impact Index Per Article: 21.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022] Open
Abstract
STUDY OBJECTIVES Although various techniques are available for obtaining pathology specimens from the mediastinal lymph nodes, including conventional bronchoscopic transbronchial needle aspiration (TBNA), transesophageal ultrasonography-guided needle aspiration, and mediastinoscopy, there are limitations to these techniques, which include low yield, poor access, need for general anesthesia, or complications. To overcome these problems, we undertook the current study to evaluate the clinical utility of the newly developed ultrasound puncture bronchoscope to visualize and perform real-time TBNA of the mediastinal and hilar lymph nodes under direct endobronchial ultrasonography (EBUS) guidance. DESIGN Prospective patient enrollment. SETTING University teaching hospital. PATIENTS From March 2002 to September 2003, 70 patients were included in the study. INTERVENTIONS The new convex probe (CP) EBUS is integrated with a convex scanning probe on its tip with a separate working channel, thus permitting real-time EBUS-guided TBNA. The indications for CP-EBUS were the diagnosis of mediastinal and/or hilar lymphadenopathy for known or suspected malignancy. Lymph nodes and the surrounding vessels were first visualized with CP-EBUS using the Doppler mode. The dimensions of the lymph nodes were recorded, followed by real-time TBNA under direct EBUS guidance. Final diagnosis was based on cytology, surgical results, and/or clinical follow-up. RESULTS All lymph nodes that were detected on the chest CT scan could be visualized using CP-EBUS. In 70 patients, CP-EBUS-guided TBNA was performed to obtain samples from mediastinal lymph nodes (58 nodes) and hilar lymph nodes (12 nodes). The sensitivity, specificity, and accuracy of CP-EBUS-guided TBNA in distinguishing benign from malignant lymph nodes were 95.7%, 100%, and 97.1%, respectively. The procedure was uneventful, and there were no complications. CONCLUSIONS Real-time CP-EBUS-guided TBNA of mediastinal and hilar lymph nodes is a novel approach that is safe and has a good diagnostic yield. This new ultrasound puncture bronchoscope has an excellent potential for assisting in safe and accurate diagnostic interventional bronchoscopy.
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Affiliation(s)
- Kazuhiro Yasufuku
- Department of Thoracic Surgery, Graduate School of Medicine, Chiba University, Japan
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Wyss P, Degen A, Caduff R, Hornung R, Haller U, Fehr M. Fluorescence hysteroscopy using 5-aminolevulinic: a descriptive study. Lasers Surg Med 2004; 33:209-12. [PMID: 12949952 DOI: 10.1002/lsm.10210] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
BACKGROUND AND OBJECTIVES To assess the feasibility of fluorescence hysteroscopy following topical ALA application and to describe the optical appearance of normal and neoplastic endometrium. STUDY DESIGN/MATERIALS AND METHODS Fifty-four patients scheduled for routine hysteroscopy and D&C were assigned to the study group using topically applied ALA. Two milliliters of a 2% 5-ALA-solution at pH = 4.0 (ASAT AG/Zug, Switzerland) was administrated into the uterine cavity 4 hours before fluorescence hysteroscopy, using a STORZ-D-Light (Tuttlingen, Germany) system. Hysteroscopic findings were compared to the histological diagnosis of hematoxylin & eosin (H&E) stained sections. In the study group, 60 histological specimens were taken (47 materials of curettage and 13 targeted biopsies). The percentage of fluorescence positive patients was calculated. RESULTS The rate of fluorescent endometrial samples was low in atrophic endometrium 1/16 (6.2%). Endometrial carcinoma were diagnosed in two patients. Both cases exhibited selective and intense PpIX-mediated red fluorescence. Fluorescence hysteroscopy could not differentiate between hyperplastic areas with or without atypia. Minimal uterine cramps or discomfort following ALA instillation were complained by 30 (56%) patients, no pain was indicated by 24 patients (44%). CONCLUSIONS Fluorescence hysteroscopy following intrauterine application of ALA is feasible. Cancerous, hyperplastic, and secretory endometrial tissue showed high red fluorescence.
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Affiliation(s)
- Pius Wyss
- Department of Obstetrics and Gynecology, University Hospital of Zurich, Zürich 8091, Switzerland.
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Shibuya K, Hoshino H, Chiyo M, Iyoda A, Yoshida S, Sekine Y, Iizasa T, Saitoh Y, Baba M, Hiroshima K, Ohwada H, Fujisawa T. High magnification bronchovideoscopy combined with narrow band imaging could detect capillary loops of angiogenic squamous dysplasia in heavy smokers at high risk for lung cancer. Thorax 2003; 58:989-95. [PMID: 14586056 PMCID: PMC1746520 DOI: 10.1136/thorax.58.11.989] [Citation(s) in RCA: 151] [Impact Index Per Article: 7.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/07/2023]
Abstract
BACKGROUND We investigated the use of high magnification bronchovideoscopy combined with narrow band imaging (NBI) for the detailed examination of angiogenic squamous dysplasia (ASD). This was carried out in relation to bronchial vascular patterns with abnormal mucosal fluorescence in heavy smokers at high risk for lung cancer. METHODS Forty eight patients with sputum cytology specimens suspicious or positive for malignancy were entered into the study. Conventional white light and fluorescence bronchoscopic examination was first performed. Observations by high magnification bronchovideoscopy with conventional white light were made primarily at sites of abnormal fluorescence, and then repeated with NBI light to examine microvascular networks in the bronchial mucosa. Spectral features on the RGB (Red/Green/Blue) sequential videoscope system were changed from the conventional RGB broadband filter to the new NBI filter. The wavelength ranges of the new NBI filter were B1: 400-430 nm, B2: 420-470 nm, and G: 560-590 nm. ASD tissues were also examined using a confocal laser scanning microscope equipped with argon-krypton (488 nm) and argon (514 nm) laser sources. RESULTS The microvessels, vascular networks of various grades, and dotted vessels in ASD tissues were clearly observed in NBI-B1 images. Diameters of the dotted vessels visible on NBI-B1 images agreed with the diameters of ASD capillary blood vessels diagnosed by pathological examination. Capillary blood vessels were also clearly visualised by green fluorescence by confocal laser scanning microscopy. There was a significant association between the frequency of dotted vessels by NBI-B1 imaging and tissues confirmed as ASD pathologically (p=0.002). CONCLUSIONS High magnification bronchovideoscopy combined with NBI was useful in the detection of capillary blood vessels in ASD lesions at sites of abnormal fluorescence. This may enable the discrimination between ASD and another pre-invasive bronchial lesion.
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Affiliation(s)
- K Shibuya
- Departments of Thoracic Surgery, Graduate School of Medicine, Chiba University, 1-8-1 Inohana, Chuo-ku, Chiba 260-8670, Japan
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Autofluorescence Bronchoscopy. Chest 2003. [DOI: 10.1016/s0012-3692(15)33711-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022] Open
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