PURPOSE: The incorporation of autofluorescence (AF) to white light bronchoscopy has led to improved sensitivity for the detection of airway pre-neoplastic lesions. However AF has difficulty distinguishing benign epithelial changes such as bronchitis, previous biopsy and airway fibrosis from pre-invasive lesions, which necessitates extensive biopsy, increases risk of bleeding from multiple biopsies and longer procedural time. We postulate that dual imaging of the tracheobronchial tree with simultaneous video and AF bronchoscopy could improve specificity leading to targeted biopsy, shorter procedural time and good correlation with pathological diagnosis.
METHODS: Forty-eight patients with known or suspected of lung cancer underwent video and AF bronchoscopy, which were provided as real-time dual images with SAFE 3000 (Pentax, Tokyo) between March and August 2006. Biopsy specimens were taken from all suspicious areas with 2 random specimens from normal areas.
RESULTS: Twenty-five suspicious sites were detected by dual imaging bronchoscopy, and 126 endobronchial biopsies were evaluated, of which 22 (17.5%) were graded as moderate dysplasia and worse. Sensitivity and specificity of dual imaging for the detection of high-grade dysplasia were 86% and 94% respectively with good correlation between bronchoscopic assessment and pathology (r=0.77, p <0.0001). However, there were 3 random biopsy specimens obtained from normal or abnormal sites that showed severe dysplasia in 2 and moderate dysplasia in 1 (Table). Median time taken for airway examination was 4 minutes (range, 4 to 4.8), and 5 minutes (range, 4 to 5) for biopsy, giving a total procedural time of 9 minutes (range, 8 to 10). There were no procedure-related complications noted.
CONCLUSION: Dual imaging that allows simultaneous real-time assessment of the lesion with video and AF bronchoscopy not only achieves satisfactory sensitivity, it also improves specificity thereby allowing targeted biopsy, marked decrease in procedural time and better patient safety.
CLINICAL IMPLICATIONS: Simultaneous video and AF bronchoscopy achieves anatomic and functional imaging of the airway leading to improved specificity and targeted biopsy of preneoplastic lesions.
DISCLOSURE: Pyng Lee, No Financial Disclosure Information; No Product/Research Disclosure Information