Direct comparison of autofluorescence bronchoscopy (AFB) and the combination of autofluorescence bronchoscopy and white light bronchoscopy (AFB + WLB) for detecting airway cancerous and precancerous lesions: a systematic review and meta-analysis

Abstract

Background: Autofluorescence bronchoscopy (AFB) presents high sensitivity but low specificity for detecting cancerous and precancerous lesions; its specificity and overall diagnostic performance may be improved when combining with white light bronchoscopy (AFB + WLB). Methods: We conducted a systematic review and meta-analysis through searching PubMed and Web of Science from the inception date of each database to 31 Dec 2017. Eligible comparative studies should contain sufficient data of AFB versus AFB + WLB to construct 2×2 tables. In addition, the samples detected by bronchoscopies should be confirmed by histopathology. The pooled sensitivity, specificity, diagnostic odds ratio (DOR) and the area under the receiver-operating characteristic curve (AUC) were estimated by a random-effect model. Results: We included seven comparative studies involving a total of 904 patients and 2,740 biopsy specimens. According to the original reported data, no specificities of AFB + WLB were higher than the specificities of AFB. In our meta-analysis, the sensitivity, specificity, DOR and AUC of AFB were 88% (95% CI: 65–97%), 63% (49–75%), 12 [3–54] and 77% (73–81%), respectively; those of AFB + WLB were 90% (77–96%), 54% (39–68%), 11 [4–34] and 78% (74–81%), respectively. Conclusions: Both AFB and AFB + WLB presented similar diagnostic performance for cancerous and precancerous lesions. In other word, AFB + WLB did not present superiority compared to AFB alone, especially in terms of the specificity.