Abstract
Background Second lung primaries occur at a rate of 2% per patient per year after curative resection for non-small cell lung carcinoma (NSCLC). The aim of this study was to evaluate the role of fluorescence bronchoscopy using the Xillix® LIFE-Lung Fluorescent Endoscopy SystemTM (LIFE-Lung system) in the surveillance of patients for second NSCLC primaries after resection or curative photodynamic therapy (PDT). Methods NSCLC patients who were disease-free following resection or endobronchial PDT were identified and recruited to participate in a LIFE bronchoscopy surveillance program. All suspicious areas were biopsied; areas of apparent normal mucosa served as negative controls. Biopsy specimens were reviewed by a single pulmonary pathologist. Results Thirty-six patients underwent 53 surveillance LIFE bronchoscopies and 6/112 biopsies revealed intraepithelial neoplasia (IEN) or invasive carcinoma in 6/36 (17%) of patients. The overall relative sensitivity of LIFE versus conventional bronchoscopy was 165% with a negative predictive value of 0.96, for the post-resection subset of patients these values increased to 200% and 0.97, respectively. Conclusions Surveillance LIFE bronchoscopy identified intraepithelial or invasive lesions in 17% of patients previously thought to be disease-free. These data support future multicenter trials on fluorescence bronchoscopic surveillance of NSCLC patients after curative surgical resection or PDT.
Highlights
About 14% of patients with invasive lung cancer can be cured using conventional treatment modalities [1]
In this trial the efficacy of fluorescence bronchoscopy in patients with suspected or proven non-small cell lung carcinoma (NSCLC) was assessed: 154 of the 173 patients in this trial were suspected ofhaving or known to have lung cancer based on symptoms and/or abnormal chest radiograph (114 patients), abnormal sputum cytology (29 patients) and 11 patients were known to have lung cancer based on prior investigations
The relative sensitivity of LIFE versus white light bronchoscopy (WLB) for invasive carcinoma was only 1.46 in this trial
Summary
About 14% of patients with invasive lung cancer can be cured using conventional treatment modalities (surgery, chemotherapy and/or radiation therapy) [1]. By the time a carcinoma ofthe lung produces symptoms and is diagnosed, it has usually progressed locally beyond resectability (Stage IIIB). Only one out of eight people diagnosed with non-small cell lung carcinoma (NSCLC) is alive at five years. The only way to significantly impact on the high mortality from lung cancer appears to be identification of the disease at an earlier stage, prior to its becoming a systemic disease. Second lung primaries occur at a rate of 2% per patient per year after curative resection for non-small cell lung carcinoma (NSCLC). The aim of this study was to evaluate the role of fluorescence bronchoscopy using the Xillix(R) LIFE-Lung Fluorescent Endoscopy SystemTM (LIFE-Lung system) in the surveillance of patients for second NSCLC primaries after resection or curative photodynamic therapy (PDT)
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