Procedures: Procedures |

AFB vs WLB for Diagnosing Airway Non-Normal Lesions With Inflammatory Changes: A Systematic Review and Meta-analysis FREE TO VIEW

Jianrong Zhang, MD; Jieyu Wu, MD; Zhiheng Xu, MD; Yujing Yang; Wenhua Liang, MD; Jianxing He, MD
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The First Affiliated Hospital of Guangzhou Medical University, Guangzhou, China

Copyright 2016, American College of Chest Physicians. All Rights Reserved.

Chest. 2016;149(4_S):A447. doi:10.1016/j.chest.2016.02.465
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SESSION TITLE: Pulmonary Procedures

SESSION TYPE: Original Investigation Slide

PRESENTED ON: Saturday, April 16, 2016 at 09:45 AM - 11:15 AM

PURPOSE: Diagnostic accuracy of autofluorescence bronchoscopy (AFB) compared with conventional white light bronchoscopy (WLB) for lung cancer has been estimated, but that for all airway non-normal lesions with inflammatory changes has not been investigated yet.

METHODS: Pubmed, Scopus, Embase, Web of Science, ProQuest, the Cochrane Library and Ovid were searched from inception to Mar 20, 2015, for eligible comparative studies containing sufficient data of AFB versus WLB to construct 2×2 table with confirmation by histopathology. Quality assessment and heterogeneity were assessed, and pooled sensitivity, specificity, diagnostic odds ratio (DOR) and the area under the receiver-operating characteristic curve (AUC) were estimated by random-effect model.

RESULTS: 6 comparative studies involving with 365 patients and 872 biopsy specimens was included. For all non-normal lesions (from inflammation to invasive carcinoma), the summary sensitivity, specificity, DOR and AUC of AFB and WLB were 0.79 (95%CI 0.63-0.89) and 0.35 (0.17-0.59) (P=0.003), 0.58 (0.26-0.84) and 0.80 (0.61-0.91) (P=0.181), 5 (1-32) and 2 (1-4) (P=0.188), 0.78 (0.74 - 0.81) and 0.64 (0.60 - 0.68) (P<0.001), respectively. For inflammatary changes only (inflammation to metaplasia), those of AFB and WLB were 0.63 (0.38-0.82) and 0.27 (0.11-0.51) (P=0.042), 0.65 (0.30-0.89) and 0.80 (0.61-0.91) (P=0.663), 3 (1-20) and 1 (1-3) (P=0.165), 0.68 (0.64 - 0.72) and 0.59 (0.55 - 0.63) (P=0.002), respectively.

CONCLUSIONS: Compared with WLB, AFB presented superior diagnostic performance regardless of airway non-normal lesions or inflammatary changes only. The performance of AFB may account for some false-positive results when diagnosing lung cancer or precancerous lesions.

CLINICAL IMPLICATIONS: Previous studies and meta-anlyses have found AFB presented higher sensitivity, DOR and AUC but lower specificity, which may cause some false-postive results when diagnosing lung cancer or precancerous lesions. This situation may be explained by our research, indicating that AFB has potential capacity to cover all airway non-normal lesions from inflammation to invasive carcinoma. Therefore, histopathological test is still the conference standard for detected lesions.

DISCLOSURE: The following authors have nothing to disclose: Jianrong Zhang, Jieyu Wu, Zhiheng Xu, Yujing Yang, Wenhua Liang, Jianxing He

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