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Original Research |

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, MSc; 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

Conflicts of interest summary:

Kayvan Amjadi, no COI disclosed. Christian Couture, no COI disclosed. Jean-Claude Cutz, no COI disclosed. David Hwang, no COI disclosed. Diana Ionescu, no COI disclosed. Sukhinder Khattra, no COI disclosed. Francis Laberge, no COI disclosed. Stephen Lam, no COI disclosed. Paul MacEachern, no COI disclosed. Simon Martel, no COI disclosed. Annette McWilliams, no COI disclosed. Serge Puksa, no COI disclosed. Harmanjatinder Sekhon, no COI disclosed. Frances A. Shepherd, no COI disclosed. Kam Soghrati, no COI disclosed. David Stather , no COI disclosed. Tom Suteja, no COI disclosed. Niloofar Taghizadeh, no COI disclosed. Martin Tammemagi, no COI disclosed. Alain Tremblay and the University of Calgary has received contract grant funding and consulting fees from Olympus America. Ming-Sound Tsao, no COI disclosed. Stefan Urbanski, no COI disclosed. Zhaolin Xu, no COI disclosed. Kazuhiro Yasufuku, no COI disclosed.

Funding information: Terry Fox Research Institute, Canadian Partnership Against Cancer, Princess Margaret Cancer Foundation Lusi Wong Fund

Corresponding author: Alain Tremblay, Division of Respiratory Medicine, Cumming School of Medicine, University of Calgary. 3330 Hospital Drive NW, Calgary, AB, Canada, T2N 4N1


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


Chest. 2016. doi:10.1016/j.chest.2016.04.019
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Abstract

Background  Lung cancer screening with low-dose chest tomography (LDCT) has been demonstrated to reduce lung cancer mortality. Preliminary reports suggested that up to 20% of lung cancers may be CT-occult but detectable by autofluorescence bronchoscopy (AFB). We evaluated the prevalence of CT occult invasive and high grade pre-invasive lesions in high risk participants undergoing screening for lung cancer.

Methods  The first 1,300 participants from 7 centers in the Pan-Canadian Early Detection of Lung Cancer Study who had 2% or greater lung cancer risk over 5 years were invited to have an AFB in addition to a LDCT. We determined the prevalence of CT and AFB abnormalities and analyzed the association between selected predictor variables and pre-invasive lesions plus invasive cancer.

Results  A total of 776 endobronchial biopsies were performed in 333/1,300 (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), carcinoma (n=4)]. Only one typical carcinoid tumor and one CIS lesion were detected by AFB alone for a rate of CT occult cancer of 0.15% [95% Confidence Interval(CI) 0.0-0.6%]. Fifty-six prevalence lung cancers were detected by LDCT (4.3%). The only independent risk factors for finding of dysplasia or CIS on AFB were smoking duration [odds ratio (95% CI)] 1.05(1.02-1.07) and FEV1% 0.99(0.98-0.99).

Conclusions  Addition of AFB to LDCT 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. (ClinicalTrials.gov number, NCT00751660.)


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