Low-dose spiral CT (LDCT) of the chest appears to be more sensitive than chest radiograph for the detection of small peripheral lung cancers, but relatively few central lung cancers are detected with this technique. In addition, the usefulness of sputum cytology for lung cancer screening in this arena is disputed. We hypothesized that autofluorescence (AF) bronchoscopy might detect central lung cancers that are missed with LDCT, and that AF bronchoscopy could be used as an “up front” screening tool in high-risk patients.
As a part of an ongoing prospective clinical trial, high risk patients were offered enrollment if they had any two (2) of the following four risk factors: A history of tobacco use which exceeds 20 pack-years in density, or A history of previously treated aerodigestive tract malignancy with no evidence of disease for >2 years, or Asbestos-related lung disease documented by chest radiograph, or COPD with a measured FEV-1 of < 70% predicted. All subjects undergo chest radiograph, LDCT, induced sputum for cytology, and AF bronchoscopy in a single outpatient visit when possible. The endpoint of the study is the detection of lung cancer.
330 subjects have been evaluated, and 161 have been enrolled onto the study. 160/161 (99%) patients were current or former smokers, with median age of 63 years. 68 (42%) patients had evidence of asbestos related lung disease, 103 (63%) had evidence of COPD, and 46 (28%) had a history of previous cancer. 9 (6%) lung cancers have been detected to date with bimodality screening, and one third (3) of these were detected with AF bronchoscopy alone and were not detected with either LDCT or sputum cytology.
AF bronchoscopy detects cancers in high risk patients that may be missed with LDCT or sputum cytology.
Bimodality lung cancer screening is feasible in a high-risk population, and offers improvement in case detection over LDCT alone.
G.M. Loewen, None.