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LUNG CANCER |
1 Center for Respiratory Medicine and Thoracic Surgery, Asklepios Fachkliniken München-Gauting, D-82131 Gauting, Germany
2 Department of Interdisciplinary Endoscopy, Thoraxklinik Heidelberg, D-69126 Heidelberg, Germany
3 Pneumologisches Zentrum, Interne Abteilung Bronchologie, A-1145 Wien, Austria
4 Schwerpunkt Pneumologie (Ch. Witt), Medizinische Klinik, Charité Campus Mitte, D-10117 Berlin, Germany
5 Pulmonological Institute Törökbálint, H-2045 Munkácsy Mihály u. 70, Hungary
6 Centro di Endoscopia e Laserterapia dell Apparato Respiratorio, Spedali Civili di Brescia, I-25123 Brescia, Italy
7 Institut für Pathologie, Berufsgenossenschaftliche Kliniken Bergmannsheil, D-44702 Bochum, Germany
8 Pneumologie, Klinikum der Universität München-Innenstadt, D-80336 Munich, Germany
9 University of Hamburg, Institute of Medical Biometry and Epidemiology, D-20246 Hamburg, Germany
10 Respiratory Division, Departement of Internal Medicine, University Hospital, CH-4031 Basel, Switzerland and University of Stellenbosch, Cape Town, South Africa
Correspondence to:
Correspondence to:
Professor K Häußinger
Center for Respiratory Medicine and Thoracic Surgery, Asklepios Fachkliniken München-Gauting, Robert-Koch-Allee 2, D-82131 Gauting, Germany; k.haeussinger{at}asklepios.com
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 
40 years of age (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.
Abbreviations: AFB, autofluorescence bronchoscopy; CIS, carcinoma in situ; WLB, white light bronchoscopy
Keywords: white light bronchoscopy; autofluorescence bronchoscopy; lung cancer; preinvasive carcinoma; screening
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