Autofluorescence bronchoscopy: Clinical experience with an optimized system in head and neck cancer patients

Abstract

Abstract Head and neck (H&N) cancer patients have a high incidence of second primary tumors in the tracheobronchial tree, which affects the patient prognosis and management. Diagnostic autofluorescence endoscopy (AFB) has shown promising results in the detection of early neoplastic and pre-neoplastic changes in the bronchi. We have investigated the medical and therapeutic impact of AFB in a population of 21 H&N cancer patients using a modified commercially available AFB system. That allows both white light (WL) and autofluorescence (AF) observation. Endoscopic imaging of the tissue AF was combined with an online image analysis procedure improving the discrimination between true and false positive results. Forty-one biopsies were taken on macroscopically suspicious (WL or AF positive) bronchial sites. Histopathologic analysis confirmed pre- or early neoplastic changes in 11 of these biopsies taken from eight patients. All these lesions had been AF positive upon bronchoscopy. The sensitivity for the detection of these early lesions with the AFB was 1.6 times the sensitivity of WL bronchoscopy alone. The positive predictive value (PPV) for AF was 79% (33% for WL alone) while the PPV of both methods together was 100%. We could demonstrate that AFB is efficient for the detection of second primary lesions of the bronchi in H&N cancer patients. In conclusion, AFB can be used as a simple and minimally invasive additional procedure to pre-operative or follow-up examination in this patient population.