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Original Research: Lung Cancer |

Low Prevalence of High-Grade Lesions Detected With Autofluorescence Bronchoscopy in the Setting of Lung Cancer Screening in the Pan-Canadian Lung Cancer Screening Study

Alain Tremblay, MDCM; Niloofar Taghizadeh, PhD; Annette M. McWilliams, MD; Paul MacEachern, MD; David R. Stather, MD; Kam Soghrati, MD; Serge Puksa, MD; John R. Goffin, MD; Kazuhiro Yasufuku, MD; Kayvan Amjadi, MD; Garth Nicholas, MD; Simon Martel, MD; Francis Laberge, MD; Michael Johnston, MD; Frances A. Shepherd, MD; Diana N. Ionescu, MD; Stefan Urbanski, MD; David Hwang, MD, PhD; Jean-Claude Cutz, MD; Harmanjatinder S. Sekhon, MD, PhD; Christian Couture, MD; Zhaolin Xu, MD; Tom G. Sutedja, MD; Sukhinder Atkar-Khattra, BSc; Martin C. Tammemagi, PhD; Ming-Sound Tsao, MD; Stephen C. Lam, MD
Author and Funding Information

FUNDING/SUPPORT: This study was funded by the Terry Fox Research Institute, the Canadian Partnership Against Cancer, and the Princess Margaret Cancer Foundation Lusi Wong Fund.

aDivision of Respiratory Medicine, University of Calgary, Calgary, AB, Canada

bFionna Stanley Hospital, Perth, WA, Australia

cPrincess Margaret Cancer Centre and University Health Network, Toronto, ON, Canada

dJuravinski Cancer Centre and McMaster University, Hamilton, ON, Canada

eOttawa Hospital, Ottawa, ON, Canada

fInstitut Universitaire de Cardiologie et de Pneumologie de Québec, Québec, QC, Canada

gBeatrice Hunter Cancer Research Institute and Dalhousie University, Halifax, NS, Canada

hBritish Columbia Cancer Agency, Vancouver, BC, Canada

iUniversity of Calgary & Foothills Medical Centre, Calgary, AB, Canada

jMcMaster University and St Joseph’s Healthcare, Hamilton, ON, Canada

kQueen Elizabeth II Health Sciences Centre, Halifax, NS, Canada

lDepartment of Respiratory Medicine, Erasmus Medical Center, Rotterdam, The Netherlands

mBrock University, St. Catharines, ON, Canada

CORRESPONDENCE TO: Alain Tremblay, MDCM, Division of Respiratory Medicine, Cumming School of Medicine, University of Calgary, 3330 Hospital Dr NW, Calgary, AB, T2N 4N1, Canada


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


Chest. 2016;150(5):1015-1022. doi:10.1016/j.chest.2016.04.019
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Background  Lung cancer screening with low-dose CT (LDCT) scan has been demonstrated to reduce lung cancer mortality. Preliminary reports suggested that up to 20% of lung cancers may be CT scan occult but detectable by autofluorescence bronchoscopy (AFB). We evaluated the prevalence of CT scan occult, invasive, and high-grade preinvasive lesions in high-risk participants undergoing screening for lung cancer.

Methods  The first 1,300 participants from seven centers in the Pan-Canadian Early Detection of Lung Cancer Study who had ≥ 2% lung cancer risk over 5 years were invited to have an AFB in addition to a LDCT scan. We determined the prevalence of CT scan and AFB abnormalities and analyzed the association between selected predictor variables and preinvasive lesions plus invasive cancer.

Results  A total of 776 endobronchial biopsies were performed in 333 of 1,300 (25.6%) participants. Dysplastic or higher-grade lesions were detected in 5.3% of the participants (n = 68; mild dysplasia: n = 36, moderate dysplasia: n = 25, severe dysplasia: n = 3, carcinoma in situ [CIS]: n = 1, and carcinoma: n = 4). Only one typical carcinoid tumor and one CIS lesion were detected by AFB alone, for a rate of CT scan occult cancer of 0.15% (95% CI, 0.0%-0.6%). Fifty-six prevalence lung cancers were detected by LDCT scan (4.3%). The only independent risk factors for finding of dysplasia or CIS on AFB were smoking duration (OR, 1.05; 95% CI, 1.02-1.07) and FEV1 percent predicted (OR, 0.99; 95% CI, 0.98-0.99).

Conclusions  The addition of AFB to LDCT scan in a high lung cancer risk cohort detected too few CT occult cancers (0.15%) to justify its incorporation into a lung cancer screening program.

Trial Registry  ClinicalTrials.gov; No.: NCT00751660; URL: www.clinicaltrials.gov

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