PURPOSE: Autofluorescence (AF) Bronchoscopy has been reported to have superior sensitivity in the detection of dysplastic and malignant bronchial epithelium when compared to fiberoptic white light bronchoscopy. This study is designed to compare the quality of fiberoptic autofluorescence bronchoscopy with latest generation white light videobronchoscopy (VB) and high magnification bronchoscopy (HMB).
METHODS: 41 mucosal biopsies were taken from 8 patients with either prior history of lung cancer (#5) or suspected lung cancer (# 3) who underwent diagnostic bronchoscopy. Bronchoscopes used were a Karl-Storz D-light autofluorescence system and the Olympus 160 series videobronchoscope. A prototype Olympus XBF-D160HM (High Magnification) broncosope was used in a subset of patients. Bronchoscopic findings were interpreted by two pulmonologists (JB and RY) and graded on a scale of I (normal), II (inflammation), Iii (dysplasia) and IV (suggestive of invasive malignancy). Airway biopsies were taken of all grade III and IV lesions, plus major lobar bronchi.
RESULTS: Sensitivity and specificity of the respective bronchoscopic methods were as follows: White light VB including high magnification: sensitivity 30%, specificity 32%, fiberoptic white light: sensitivity: 30%, specificity: 45%, AF: sensitivity:. 50%, specificity 37%. False positive results for AF bronchosopy were frequently observed in areas of surgical margins, inflammation and biopsy sites. Lesions missed by AF bronchoscopy were four lesions of squamous metaplasia and one low grade dysplasia. No high grade lesion was missed.
CONCLUSION: Bronchoscopy with AF imaging has superior sensitivity and equal specificity when compared with the newest video white light bronchoscopes and conventional fiberoptic white light bronchoscopy. Video bronchoscopes do not offer additional sensitivity over fiberoptic white light bronchoscopes.
CLINICAL IMPLICATIONS: When diagnostic bronchoscopy with AF was initially compared with fiberoptic white light bronchoscopy, it was suggested that the observed benefit from AF will not persist when compared with the advanced white light video bronchoscopy. Our data confirm a trend towards superiority of AF bronchoscopy over video white light bronchoscopy with or without high magnfication features. Further studies with larger numbers are needed to confirm this trend.
DISCLOSURE: Johann Brandes, None.
Johann C. Brandes MD * Loretta Colvin RN Rex Yung MD Johns Hopkins University School of Medicine, Baltimore, MD
COPYRIGHT 2005 American College of Chest Physicians
COPYRIGHT 2005 Gale Group
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