PURPOSE: The search for most efficient bronchoscopic imaging tool in detection of early lung cancer is still active. The major aim of this study was to determine sensitivity, specificity, positive (PPV) and negative predictive value (NPV) of each technique and their combination in detection of premalignant bronchial lesions.
METHODS: This was a prospective trial that enrolled 96 patients with indication for bronchoscopy. Major indications were: radiological suspicion for lung cancer, surveillance of patients after surgery, evaluation of known malignancy, positive sputum cytology and prolonged cough. In each patient at least one but no more than 3 biopsies were taken from places identified as pathological under white light videobronchoscopy (WLB), AFI, NBI or their combination. At least one, but no more than 3 biopsies were taken randomly from places that appeared normal under each technique. Lesions were classified as visually positive if pathological fluorescence was observed under AFI or, dotted, tortuous and abrupt ending blood vessels were identified under NBI. Squamous metaplasia, mild, moderate or severe dysplasia and CIS were regarded as histologically positive lesion were.
RESULTS: Sensitivity, specificity, PPV and NPV of WLB in detection of premalignant lesions were 26.5%, 63.9%, 34.4% and 54.9% respectively, corresponding values for AFI were 52%, 79.6%, 64.6% and 69.9% respectively,and for NBI 66%, 84.6%, 75.4%, 77.7%, respectively, while corresponding values for combination of NBI and AFI were 86.1%, 86.6%, 84.6%, and 88% respectively. Combination of NBI and AFI significantly improves sensitivity when compared to each individual technique (p<0.001). When specificity is of concern combination of techniques improves specificity of WLB (p<0.001), specificity of AFI (p=0.03) but it has no significant influence on specificity of NBI (p=0.53).
CONCLUSIONS: Combination of NBI and AFI in detection of premalignant bronchial lesions increases both sensitivity and specificity of each technique. However more prospective, randomized data are needed to validate and confirm these findings.
CLINICAL IMPLICATIONS: Each individual technique, AFI and NBI, has better sensitivity and specificity for detection of precancerous lesions of the bronchi when compared to the WLB. However, the results of this study suggest that combination of techniques is not significantly better than NBI. When possible, the techniques could be combined in order to increase specificity and sensitivity in detection of precancerous bronchial lesions.
DISCLOSURE: The following authors have nothing to disclose: Bojan Zaric, Branislav Perin, Svetlana Jovanovic, Evica Budisin, Goran Stojanovic, Nensi Lalic, Milan Antonic
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