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Localization of Bronchial Intraepithelial Neoplastic Lesions by Fluorescence Bronchoscopy

Stephen Lam; Timothy Kennedy; Michael Unger; York E. Miller; David Gelmont; Valerie Rusch; Bruce Gipe; David Howard; Jean C. LeRiche; Andrew Coldman; Adi F. Gazdar
Author and Funding Information

Affiliations: From the British Columbia Cancer Agency, Vancouver, BC, Canada,  From the Presbyterian/St Luke's Medical Center, University of Colorado Cancer Center, Denver,  From the Pennsylvania Hospital, Philadelphia,  From the Denver Veterans Affairs Medical Center, University of Colorado Cancer Center, Denver,  From the University of Southern California/Kenneth Norris Jr. Cancer Center, Los Angeles,  From the Memorial Sloan-Kettering Cancer Center, New York,  From the University of California, Los Angeles,  From the Evansville Cancer Center/St. Mary's Hospital, Evansville, Ind,  From the Department of Pathology, British Columbia Cancer Research Centre, Vancouver, BC,  From the Department of Epidemiology, British Columbia Cancer Research Centre, Vancouver, BC,  From the Department of Pathology, Hamon Cancer Center, UT Southwestern Medical Center at Dallas

Affiliations: From the British Columbia Cancer Agency, Vancouver, BC, Canada,  From the Presbyterian/St Luke's Medical Center, University of Colorado Cancer Center, Denver,  From the Pennsylvania Hospital, Philadelphia,  From the Denver Veterans Affairs Medical Center, University of Colorado Cancer Center, Denver,  From the University of Southern California/Kenneth Norris Jr. Cancer Center, Los Angeles,  From the Memorial Sloan-Kettering Cancer Center, New York,  From the University of California, Los Angeles,  From the Evansville Cancer Center/St. Mary's Hospital, Evansville, Ind,  From the Department of Pathology, British Columbia Cancer Research Centre, Vancouver, BC,  From the Department of Epidemiology, British Columbia Cancer Research Centre, Vancouver, BC,  From the Department of Pathology, Hamon Cancer Center, UT Southwestern Medical Center at Dallas

Affiliations: From the British Columbia Cancer Agency, Vancouver, BC, Canada,  From the Presbyterian/St Luke's Medical Center, University of Colorado Cancer Center, Denver,  From the Pennsylvania Hospital, Philadelphia,  From the Denver Veterans Affairs Medical Center, University of Colorado Cancer Center, Denver,  From the University of Southern California/Kenneth Norris Jr. Cancer Center, Los Angeles,  From the Memorial Sloan-Kettering Cancer Center, New York,  From the University of California, Los Angeles,  From the Evansville Cancer Center/St. Mary's Hospital, Evansville, Ind,  From the Department of Pathology, British Columbia Cancer Research Centre, Vancouver, BC,  From the Department of Epidemiology, British Columbia Cancer Research Centre, Vancouver, BC,  From the Department of Pathology, Hamon Cancer Center, UT Southwestern Medical Center at Dallas

Affiliations: From the British Columbia Cancer Agency, Vancouver, BC, Canada,  From the Presbyterian/St Luke's Medical Center, University of Colorado Cancer Center, Denver,  From the Pennsylvania Hospital, Philadelphia,  From the Denver Veterans Affairs Medical Center, University of Colorado Cancer Center, Denver,  From the University of Southern California/Kenneth Norris Jr. Cancer Center, Los Angeles,  From the Memorial Sloan-Kettering Cancer Center, New York,  From the University of California, Los Angeles,  From the Evansville Cancer Center/St. Mary's Hospital, Evansville, Ind,  From the Department of Pathology, British Columbia Cancer Research Centre, Vancouver, BC,  From the Department of Epidemiology, British Columbia Cancer Research Centre, Vancouver, BC,  From the Department of Pathology, Hamon Cancer Center, UT Southwestern Medical Center at Dallas

Affiliations: From the British Columbia Cancer Agency, Vancouver, BC, Canada,  From the Presbyterian/St Luke's Medical Center, University of Colorado Cancer Center, Denver,  From the Pennsylvania Hospital, Philadelphia,  From the Denver Veterans Affairs Medical Center, University of Colorado Cancer Center, Denver,  From the University of Southern California/Kenneth Norris Jr. Cancer Center, Los Angeles,  From the Memorial Sloan-Kettering Cancer Center, New York,  From the University of California, Los Angeles,  From the Evansville Cancer Center/St. Mary's Hospital, Evansville, Ind,  From the Department of Pathology, British Columbia Cancer Research Centre, Vancouver, BC,  From the Department of Epidemiology, British Columbia Cancer Research Centre, Vancouver, BC,  From the Department of Pathology, Hamon Cancer Center, UT Southwestern Medical Center at Dallas

Affiliations: From the British Columbia Cancer Agency, Vancouver, BC, Canada,  From the Presbyterian/St Luke's Medical Center, University of Colorado Cancer Center, Denver,  From the Pennsylvania Hospital, Philadelphia,  From the Denver Veterans Affairs Medical Center, University of Colorado Cancer Center, Denver,  From the University of Southern California/Kenneth Norris Jr. Cancer Center, Los Angeles,  From the Memorial Sloan-Kettering Cancer Center, New York,  From the University of California, Los Angeles,  From the Evansville Cancer Center/St. Mary's Hospital, Evansville, Ind,  From the Department of Pathology, British Columbia Cancer Research Centre, Vancouver, BC,  From the Department of Epidemiology, British Columbia Cancer Research Centre, Vancouver, BC,  From the Department of Pathology, Hamon Cancer Center, UT Southwestern Medical Center at Dallas

Affiliations: From the British Columbia Cancer Agency, Vancouver, BC, Canada,  From the Presbyterian/St Luke's Medical Center, University of Colorado Cancer Center, Denver,  From the Pennsylvania Hospital, Philadelphia,  From the Denver Veterans Affairs Medical Center, University of Colorado Cancer Center, Denver,  From the University of Southern California/Kenneth Norris Jr. Cancer Center, Los Angeles,  From the Memorial Sloan-Kettering Cancer Center, New York,  From the University of California, Los Angeles,  From the Evansville Cancer Center/St. Mary's Hospital, Evansville, Ind,  From the Department of Pathology, British Columbia Cancer Research Centre, Vancouver, BC,  From the Department of Epidemiology, British Columbia Cancer Research Centre, Vancouver, BC,  From the Department of Pathology, Hamon Cancer Center, UT Southwestern Medical Center at Dallas

Affiliations: From the British Columbia Cancer Agency, Vancouver, BC, Canada,  From the Presbyterian/St Luke's Medical Center, University of Colorado Cancer Center, Denver,  From the Pennsylvania Hospital, Philadelphia,  From the Denver Veterans Affairs Medical Center, University of Colorado Cancer Center, Denver,  From the University of Southern California/Kenneth Norris Jr. Cancer Center, Los Angeles,  From the Memorial Sloan-Kettering Cancer Center, New York,  From the University of California, Los Angeles,  From the Evansville Cancer Center/St. Mary's Hospital, Evansville, Ind,  From the Department of Pathology, British Columbia Cancer Research Centre, Vancouver, BC,  From the Department of Epidemiology, British Columbia Cancer Research Centre, Vancouver, BC,  From the Department of Pathology, Hamon Cancer Center, UT Southwestern Medical Center at Dallas

Affiliations: From the British Columbia Cancer Agency, Vancouver, BC, Canada,  From the Presbyterian/St Luke's Medical Center, University of Colorado Cancer Center, Denver,  From the Pennsylvania Hospital, Philadelphia,  From the Denver Veterans Affairs Medical Center, University of Colorado Cancer Center, Denver,  From the University of Southern California/Kenneth Norris Jr. Cancer Center, Los Angeles,  From the Memorial Sloan-Kettering Cancer Center, New York,  From the University of California, Los Angeles,  From the Evansville Cancer Center/St. Mary's Hospital, Evansville, Ind,  From the Department of Pathology, British Columbia Cancer Research Centre, Vancouver, BC,  From the Department of Epidemiology, British Columbia Cancer Research Centre, Vancouver, BC,  From the Department of Pathology, Hamon Cancer Center, UT Southwestern Medical Center at Dallas

Affiliations: From the British Columbia Cancer Agency, Vancouver, BC, Canada,  From the Presbyterian/St Luke's Medical Center, University of Colorado Cancer Center, Denver,  From the Pennsylvania Hospital, Philadelphia,  From the Denver Veterans Affairs Medical Center, University of Colorado Cancer Center, Denver,  From the University of Southern California/Kenneth Norris Jr. Cancer Center, Los Angeles,  From the Memorial Sloan-Kettering Cancer Center, New York,  From the University of California, Los Angeles,  From the Evansville Cancer Center/St. Mary's Hospital, Evansville, Ind,  From the Department of Pathology, British Columbia Cancer Research Centre, Vancouver, BC,  From the Department of Epidemiology, British Columbia Cancer Research Centre, Vancouver, BC,  From the Department of Pathology, Hamon Cancer Center, UT Southwestern Medical Center at Dallas

Affiliations: From the British Columbia Cancer Agency, Vancouver, BC, Canada,  From the Presbyterian/St Luke's Medical Center, University of Colorado Cancer Center, Denver,  From the Pennsylvania Hospital, Philadelphia,  From the Denver Veterans Affairs Medical Center, University of Colorado Cancer Center, Denver,  From the University of Southern California/Kenneth Norris Jr. Cancer Center, Los Angeles,  From the Memorial Sloan-Kettering Cancer Center, New York,  From the University of California, Los Angeles,  From the Evansville Cancer Center/St. Mary's Hospital, Evansville, Ind,  From the Department of Pathology, British Columbia Cancer Research Centre, Vancouver, BC,  From the Department of Epidemiology, British Columbia Cancer Research Centre, Vancouver, BC,  From the Department of Pathology, Hamon Cancer Center, UT Southwestern Medical Center at Dallas


1998 by the American College of Chest Physicians


Chest. 1998;113(3):696-702. doi:10.1378/chest.113.3.696
Text Size: A A A
Published online

Abstract

Background: In the treatment of lung cancer, the best outcome is achieved when the lesion is discovered in the intraepithelial (preinvasive) stage. However, intraepithelial neoplastic lesions are difficult to localize by conventional white-light bronchoscopy (WLB).

Objective: To determine if autofluorescence bronchoscopy, when used as an adjunct to WLB, could improve the bronchoscopist's ability to locate and remove biopsy specimens from areas suspicious of intraepithelial neoplasia as compared with WLB alone.

Method: A multicenter clinical trial was conducted in seven institutions in the United States and Canada. WLB followed by fluorescence examination with the light-induced fluorescence endoscopy (LIFE) device was performed in 173 subjects known or suspected to have lung cancer. Biopsy specimens were taken from all areas suspicious of moderate dysplasia or worse on WLB and/or LIFE examination. In addition, random biopsy specimens were also taken from other parts of the bronchial tree.

Results: The relative sensitivity of WLB+LIFE vs WLB alone was 6.3 for intraepithelial neoplastic lesions and 2.71 when invasive carcinomas were also included. The positive predictive value was 0.33 and 0.39 and the negative predictive value was 0.89 and 0.83, respectively, for WLB+LIFE and WLB alone.

Conclusion: Autofluorescence bronchoscopy, when used as an adjunct to standard WLB, enhances the bronchoscopist's ability to localize small neoplastic lesions, especially intraepithelial lesions that may have significant implication in the management of lung cancer in the future.


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