Conventional White-light Bronchoscopy Research Articles

Robotic-assisted bronchoscopy for peripheral pulmonary lesions: A single-center experience of the Ion platform

Rationale: The diagnostic yield of electromagnetic navigational bronchoscopy to access lung lesions remains low. The multicenter NAVIGATE study showed the diagnostic yield to be 71% for lesions up to 3 cm and 67% for lesions up to 2 cm. The introduction of robotic-assisted navigational platforms may overcome some of the traditional barriers encountered with previous approaches. We aim to assess the navigational and diagnostic yield of the Ion™ endoluminal system (Intuitive Surgical, Inc., Sunnyvale, California) regarding pulmonary lesions that could not previously be biopsied using conventional white light bronchoscopy. Methods: We retrospectively reviewed and analyzed data from our first 76 consecutive robotic-assisted navigational bronchoscopy (RAB) cases performed by a single proceduralist at our single center between March 11, 2020, to November 25, 2020. Secondary endpoints included the safety of the platform, such as incidences of pneumothoraces and significant bleeding events. Results: The ability to localize the lesion using the shape sensing technology was 100% (n=76). Navigational success, as determined by lesion visualization using radial endobronchial ultrasound confirmation, was 76% (n=58) of the nodules. The additional use of 2D-fluoroscopy for needle-in-lesion guidance and Rapid Onsite Evaluation to assess for adequate tissue sampling resulted in a diagnostic yield of 92% (n=70). There was a 0% complication rate for pneumothorax and significant bleeding events in the postoperative phase. Conclusions: Our study supports the current literature regarding the safety and efficacy of the Ion™ RAB for use in obtaining biopsy of peripheral lung lesions. Depending on the definition of navigational success, based on our results, the Ion™ RAB is comparable to or better than flexible bronchoscopy. The diagnostic yield is comparable to or better than flexible bronchoscopy but slightly lower than the gold standard computed tomography-guided transthoracic biopsy (CTTB) for peripheral lung lesions. However, in contrast to CTTB, the Ion™ RAB has lower complication rates for pneumothoraces and major bleeding. Further studies are needed to directly compare the current two robotic systems with a third system, Galaxy System™ by Noah Medical that is pending FDA approval.

Role of high-definition bronchoscopy in histopathological diagnosis of bronchogenic carcinoma according to bronchial vascular patterns

Background Owing to technological advances, a novel technique has become available, called high-definition (HD) bronchoscopy, giving substantially higher resolution images than conventional white light bronchoscopy and producing signal images with resolutions ranging from 850 000 pixels to more than 1 million pixels. HD bronchoscopes are designed for image output onto commercial TVs or computer monitors via i-scan video device. Aim The aim of this study was to determine the relation between different vascular patterns and histopathological type of bronchogenic carcinoma by using HD bronchoscopy and i-scan. Patients and methods The study was performed at Chest Department, Ain Shams University Hospital, from January 2015 till January 2016. The study included 30 patients, comprising 24 males and six females, with age ranging from 45 to 73 years. Bronchogenic carcinoma was diagnosed in all patients: 10 patients had squamous cell type, eight patients had adenocarcinoma, seven patients had small cell type, and five cases had large cell type. All patients were subjected to full history taking, complete clinical examination, and radiographic studies including plain chest radiography and computerized tomography of the chest. Laboratory evaluations included complete blood count, liver functions, renal functions, prothrombin time, partial thromboplastin time, international normalized ratio, and spirometry if needed. All cases were prepared and examined by HD PENTAX 3.2 Medical 70K-series (EB-1970TK) video bronchoscope and i-scan Video Processor EPK-i 5000. Results There was a statistically significant association between vascular pattern and pathology of bronchogenic carcinoma. Tortuous vessels were identified in 80% of patients with squamous cell carcinoma, 60% of large cell type, 42.8% of small cell type, and 12.5% of patients of adenocarcinoma. Dotted vessels were identified in 78.5% of adenocarcinoma cases, 42.8% of small cell type, 20% of large cell type, and 10% of squamous cell type. Abrupt-ending vessels were identified in 10% of squamous cell carcinoma cases, 14.4% of small cell type, and 20% of large cell type. Incidence of tortuous vessels in cases with squamous cell carcinoma was significantly greater (7.429 times) than nontortuous vessels. Incidence of dotted vessels in cases with adenocarcinoma was significantly higher (23.80 times) than nondotted vessels. Conclusion Advanced bronchoscopic technologies may enable obtaining an ‘optical biopsy’ of the bronchial tree, providing high-resolution and three-dimensional virtual images. These technologies may fundamentally improve the diagnostic and therapeutic assessment of bronchial tumors.

Comparison of narrow band imaging to white light bronchoscopy for evaluation of histopathological biopsy

BackgroundIt is difficult to detect precancerous lesions such as dysplasia and carcinoma in situ (CIS) by conventional white light bronchoscopy (WLB). Narrow Band Imaging Bronchoscopy (NBI) has been reported to detect such lesions more readily. ObjectiveThe objective of the present study is to characterize the appearance of different airway mucosal lesions under NBI mode and to evaluate the role of NBI compared to WLB in diagnosis of premalignant and malignant lesions. Methods30 patients presented with radiological changes to chest department in Fayoum University Hospital. They were subjected to full airway examination by fiberoptic bronchoscopy first under WLB then under NBI. Biopsies were taken from susceptible lesions; pathological interpretation was performed. Results18 patients (60%) were proved by NBI to have invasive carcinoma compared to 11 patients (36.7%) by WLB. 3 patients (10%) were proved by NBI to have severe dysplasia/CIS compared to 6 patients (20%) by WLB. 3 patients (10%) were proved by NBI to have mild/moderate dysplasia compared to 4 patients (13.3%) by WLB (p value=0.03). The sensitivity of both WLB and NBI (76.9%) is better than WLB alone or NBI alone (9.1% and 57.1% respectively) in detecting premalignant lesions while the sensitivity of both WLB and NBI (52.6%) is less than WLB alone (55.6%) and better than NBI alone (26.7%) in detecting malignant lesions. ConclusionNBI can be used in combination with WLB to improve detection of premalignant lesions. It influences biopsy selection and therapeutic planning.

Value of Autofluorescence Imaging Videobronchoscopy in Detecting Lung Cancers and Precancerous Lesions: A Review

Bronchoscopy technology is a desirable method for detecting lung cancers arising in the central airways. Most early cancers and precancerous lesions are not visible on conventional white-light bronchoscopy (WLB). Autofluorescence bronchoscopy (AFB) is a newly developed technology that exploits the difference in autofluorescence intensity between normal and tumorous tissues to detect bronchial cancers and precancerous lesions. Several types of AFB systems have been used in clinical practice, and autofluorescence imaging videobronchoscopy (AFI) is one of these AFBs. In most of the studies on AFB other than AFI, AFB has provided a much higher sensitivity but a lower specificity than WLB. Regarding AFI, recent studies have reported controversial results on the sensitivity and specificity for detecting cancers and precancerous lesions, compared with WLB. In this paper we describe the working mechanisms and characteristics of AFBs, mainly AFI, and the diagnostic performance of AFI, compared with WLB, other AFBs, and narrow-band imaging, for detecting lung cancers and precancerous lesions.

The role of endobronchial ultrasound in central early lung cancer.

Central early lung cancers (CELC) are tumors arising from the central airways, roentgenographically occult, which are usually diagnosed by bronchoscopy after a positive sputum cytology. Most CELCs are undetectable for conventional white light bronchoscopy (WLB) but can be identified under autofluorescence bronchoscopy (AFB). Although AFB increases the sensitivity of WLB in detecting CELC, its low specificity remains a problem. Surgery has been the most accepted treatment for CELCs; however 20-30% of patients suffering CELC tend to have multicentricities and usually present with poor cardiopulmonary status. Therefore, surgery is not suitable in most of the cases and other therapeutic options such as bronchoscopic treatments should be considered. Because most endoscopic treatments are unlikely to be curative if the tumor has spread beyond the bronchial cartilage, accurate evaluation of CELC bronchial wall invasion is critical before selecting a bronchoscopic treatment. Endobronchial ultrasound (EBUS) is a relatively new technique that has proven to be useful in the evaluation of the normal and cancer-invaded bronchial wall. Some authors have demonstrated that after adding EBUS assessment to AFB in autofluorescence-positive lesions the specificity increases from 50 to 90%. Other studies have focused on the ability of EBUS to detect bronchial wall invasion in patients with CELCs. They compared the EBUS images with pathological findings of surgical specimens of patients that underwent surgery; in most of the cases the correlation between EBUS and pathological findings increased over 90%. Furthermore, in patients not eligible for surgery, EBUS has proven to predict patients expected response to endoscopic treatments.

The Use of Narrow Band Imaging in Patients With Benign Disease

: Narrow band imaging (NBI) is a new type of imaging technology that enhances the visibility of blood vessels used in the detection of abnormal angiogenesis in preneoplastic and neoplastic lesions. This technique is used in the diagnosis and management of dysplastic and malignant endobronchial lesions. To our knowledge, this is the first description of the use of NBI to diagnose and manage benign lesions, hereditary hemorrhagic telangiectasia (HHT). The objective of this study was to implement NBI as a tool for use in the bronchoscopic visualization leading to the diagnosis and management of nonmalignant lesions in the tracheobronchial tree. This is including but not limited to HHT. NBI was used to detect the origin of significant hemoptysis in a patient with HHT. The patient had conventional white light (CWL) bronchoscopy, followed by NBI. NBI illuminated the abnormal blood vessels significantly better than CWL bronchoscopy. This led to a more effective diagnosis and management of the abnormal vessels causing the hemoptysis. NBI may provide a higher probability of locating abnormal endobronchial lesions in both benign and malignant diseases than CWL bronchoscopy. It can be used to treat these abnormal lesions as in our patient who presented with hemoptysis. A prospective study is needed to determine whether NMI and CWL are additive as in malignant disease. Furthermore, NBI can be used in lesions of the tracheobronchial tree and the gastrointestinal tract, and pleura, so that the appropriate management can be initiated.

Autofluorescence Bronchoscopy

Due to advances in interventional bronchoscopy, curative treatment has become possible for central type lung cancer if it is detected in the early stage. However, expertise is required to diagnose the intraepithelial lesions by conventional white light bronchoscopy alone, but judgement is still subjective. The combination of white light and autofluorescence bronchoscopy has been reported to show better sensitivity in detecting dysplasia and cancer of the bronchus than white light alone. Thus, abnormal sputum cytology findings are good indications for this examination. Autofluorescence bronchoscopy also can capture the extent of tumor precisely, therefore it is helpful to decide the bronchial resection line preoperatively or the area to treat before endoscopic therapy. However, discrimination between cancerous/precancerous lesions and inflammation is sometimes difficult by endoscopic images alone, and histological diagnosis is still the gold standard. Recently, videoendoscopy-based autofluorescence systems have been created and used clinically. These systems had significantly higher sensitivity for intraepithelial lesions as well as higher specificity than white light videoendoscopy alone.

P1-186: Usefulness of autofluorescence bronchoscopy for detecting bronchial premalignant lesions

Background : Autofluorescence bronchoscopy (AFB), when used as an adjunct to conventional white light bronchoscopy (WLB) improves the bronchoscopist's ability to localized small intraepithelial lesions. Current study was undertaken to evaluate prevalence of preinvasive intraepithelial lesions (dysplasia II-III & CIS) and efficacy of additional AFB system to WLB in comparison with WLB alone. Methods : In patients with suspicion of lung cancer or follow-up ones with known lung cancer, WLB (Pentax; BP 3500, Japan) and AFB (Richard Wolf, Germany) were done and all subjects with endoscopic abnormalities underwent biopsies from January 2005 to December 2005. Results : 169 patients (134 suspected to have lung cancer radiologically, 18 with known lung cancer, and 17 with initial abnormal WLB visual findings) were enrolled. Overall preinvasive intraepithelial lesions were detected in 6.5% (11 persons). Biopsy based sensitivity of WLB+AFB and WLB alone for detecting preinvasive intraepithelial lesions was 77.8% compared with 22.2% (relative ratio 3.5, 95% CI 0.93-13.24). Corresponding specificity was 56.9% compared with 89.2% (relative ratio 0.64, 95% CI 0.54-0.75). The positive predicitve value was 6% and 3%, and the negative predictive value was 94% and 87%, respectively, for WLB+AFB and WLB alone. Conclusions : WLB+AFB was superior to WLB alone in detecting preinvasive intraepithelial lesions, but general use of AFB as a screening tool seems to be limited in suspected or known lung cancer group because of low prevalence. It is necessary of further study for precise indication for AFB among the lung cancer risk groups.(Korean J Med 71:67-74, 2006)

Narrow Band Imaging in the Airway: Where Do We Stand?

Narrow Band Imaging in the Airway: Where Do We Stand?

Clinical Experience with Autofluorescence Imaging System in Patients with Lung Cancers and Precancerous Lesions

Background: It is important to detect preinvasive bronchial lesions before they become invasive cancer, because detection of early cancer is expected to lead to a cure. Autofluorescence bronchoscopy is a useful device in the detection of preinvasive and cancerous lesions. Recently, a new autofluorescence bronchoscopic system, autofluorescence imaging (AFI) system, has been developed. Objectives: We evaluated the efficacy of AFI in the diagnosis of precancerous and cancerous lesions. Methods: A total of 31 patients underwent both conventional white-light bronchoscopy (WLB) and AFI from January 2002 to September 2004. We evaluated autofluorescence findings using a four-point scale: AFI-I, II, III, and B. The findings in WLB were evaluated on a three-point scale: WLB-I, II, and III. Abnormal areas by WLB and AFI were biopsied for histopathological examinations. Results: A total of 64 lesions were evaluated. When the AFI-III finding was regarded as positive in AFI and WLB-III as positive in WLB, sensitivity for severe dysplasia or worse was 94.7% with AFI and 73.7% with WLB, respectively. Conclusions: AFI is an effective system for the detection of precancerous and cancerous lesions.

Fluorescent bronchoscopy: contribution for lung cancer screening?

The majority of early lesions, even when centrally located, is missed by conventional white-light (WL) bronchoscopy. Fluorescent bronchoscopy is a promising tool in localising early malignant changes in the central airways, because it is significantly more sensitive than WL bronchoscopy. Originally, drug-induced fluorescence has been used, but today autofluorescence bronchoscopy is more common in relation to its simplicity and advantages. Different systems are available which yield comparable results. However, there are no studies comparing all systems. The disadvantage is the low specificity of the method. Fluorescent bronchoscopy will be more effective if carried out in high-risk patients and/or embedded in a program of preprocedural evaluation of sputum and together with a CT examination of the thorax. But a reduction of mortality as a result of such efforts has not been shown until the present time.

Phonation bronchoscopy

Fluorescence bronchoscopy is one of the methods of the early detection of lung cancer that involves the large airways. The method is based on the detection of the altered autofluorescence of malignantly transformed tissue, and confirmed by biopsy and histopathologic examination. Fluorescence bronchoscopy was performed in 18 patients, mean age of 51.2 years (male n = 12, female n = 6) due to the suspected lung cancer. Fluorescence bronchoscopy was performed using the Xillix LIFE-Lung System, Vancouver, Canada. After conventional white-light bronchoscopy, the tracheobronchial tree was illuminated by blue light (442 nm) using helium-cadmium laser, and the results of autofluorescence were classified into three classes. Normal mucosa was of green fluorescence (Class I), abnormal mucosa was red or dark brown fluorescence (Class II and II), which was the indication for performing biopsy. Normal endoscopy findings were established in 15 patients by conventional bronchoscopy. In the same group, by fluorescence bronchoscopy, Class I of fluorescence (normal finding) was found in 9 patients, while Class II changes occurred in 6 patients. Histopathologic analysis of bronchial mucosa with Class II changes was performed detecting planocellular carcinoma in situ in one patient. Tumor-like changes were detected in 3 patients by conventional bronchoscopy, and were determined as Class III changes by fluorescence bronchoscopy. By the biopsy of these chages carcinoma was documented in 2 patients while in one patient metaplasia of epithelium and granulation tissue around aspirated foreign body was detected. Fluorescence bronchoscopy is one of the methods for detecting metaplasia, carcinoma in situ and cancerous changes of bronchial epithelium in the large airways. However, the high rate of falsely positive findings represents a limitation of this method.

Is Autofluorescence Bronchoscopy Needed to Diagnose Early Bronchogenic Carcinoma?

Is Autofluorescence Bronchoscopy Needed to Diagnose Early Bronchogenic Carcinoma?

Diagnostic results before and after introduction of autofluorescence bronchoscopy in patients suspected of having lung cancer detected by sputum cytology in lung cancer mass screening

For the purpose of early detection, we have conducted population-based mass screening for lung cancer by sputum cytology since 1982. Although detection of lung cancer in its early stage is important for a good prognosis, it is often difficult to localize lesions in roentgenographically occult cancer. To clarify the role of autofluorescence bronchoscopy in localizing tumors in patients with roentgenographically occult cancer, we analyzed our diagnostic results. Fifty patients who had been detected by sputum cytology were screened by the light-induced fluorescence endoscope (LIFE)-Lung System from November 1997 to April 1999. We compared the results according to the screening methods: conventional bronchoscopy alone versus LIFE with conventional white-light bronchoscopy (November 1997 to April 1999). Twenty-eight cancerous lesions and 39 borderline lesions were detected by LIFE. Of the 39 borderline lesions, nine were detected only by LIFE. Multicentric lesions including cancer or dysplasia were also detected in 21 of the 50 patients by LIFE. The sensitivity by white-light bronchoscopy alone was 85.3%, whereas that of the LIFE-Lung System with white-light bronchoscopy was 94.1% ( P=0.078). There were no cancerous lesions in the area observed as normal by LIFE. We also compared the diagnostic results of two localization methods: brushing of all bronchi (September 1986 to December 1990) and the LIFE-Lung System (November 1997 to April 1999). Although this was a historical comparison, the number of detected borderline lesions increased, which led to a high detection rate in patients with suspected-positive sputum ( P=0.0006) by the LIFE-Lung System. In conclusion, the LIFE-Lung System is a safe and non-invasive system for detecting small intraepithelial lesions of the tracheobronchial tree. Autofluorescence bronchoscopy is more efficacious for localizing intraepithelial lesions and places fewer burdens on the patient than brushing of all bronchi.

The clinical value of lung imaging fluorescence endoscopy for detecting synchronous lung cancer

Some patients with non-small cell lung cancer (NSCLC) will also have a synchronous malignant lesion. The lung imaging fluorescence endoscopy (LIFE) has proven better than conventional white light bronchoscopy (WLB) for visualizing premalignant lesions or early stages of lung cancer. In this study, the additional value of LIFE in diagnosing synchronous lung cancers as well as the impact of these findings on definite therapy was analyzed. Seventy-two patients with recently diagnosed NSCLC or pulmonary lesions highly suspect of lung cancer were studied. Patients underwent WLB, followed by LIFE. Apart from the primary lesions, additional abnormal and suspicious lesions seen at WLB and LIFE were scored separately and biopsied. Sixty-nine patients had NSCLC and three patients had small cell lung carcinoma. Apart from the primary lesion, one up to six additional endobronchial lesions were visualized in 48 patients by WLB and/or LIFE. High-grade dysplastic lesions were detected in ten patients, three of whom were eligible for surgery of the primary tumor after completion of the investigations. Three other patients (4.3%) had synchronous cancers (NSCLC). In one patient, the lesion was visualized by LIFE and by WLB. The other two malignant lesions were detected only by LIFE. In these three latter patients, diagnostic work-up and definite treatment was changed, as a result of detection of synchronous lesions. In conclusion, LIFE has additional value in detecting synchronous malignant lesions in patients with primary lung cancer. The detection of these lesions changed diagnostic work-up and definite treatment plan. Therefore, LIFE should be used in the work-up of patients with primary lung cancer.

Fluorescence bronchoscopy in the detection of preinvasive bronchial lesions in patients with sputum cytology suspicious or positive for malignancy

Background: a new strategy in the treatment of squamous cell carcinoma of the tracheobronchial tree is the detection and eradication of preinvasive bronchial lesions before they become invasive cancers. It is, however, difficult to detect preinvasive lesions by conventional white-light bronchoscopy alone. Purpose: we conducted a detailed investigation on the use of fluorescence bronchoscopy in the detection of preinvasive bronchial lesions in patients with sputum cytology suspicious or positive for malignancy. Methods: 64 participants with sputum cytology suspicious or positive for malignancy were examined with both white light and fluorescence bronchoscopy (LIFE group). Earlier to this study, before fluorescence bronchoscopy became available in our institute, 48 participants having sputum cytology suspicious or positive for malignancy were examined with white light bronchoscopy alone (control group). Biopsy specimens for pathological examinations were taken of all abnormal areas discovered by white light or fluorescence bronchoscopy examination. Results: in sputum cytology suspicious or positive for malignancy, the diagnosis of preinvasive bronchial lesions was greatly enhanced in the LIFE group as compared with the control group (45 vs. 7 lesions). The percentage of participants with preinvasive bronchial lesions was also significantly higher in the LIFE group than in the control group (40.6 vs. 12.5%, P=0.00087, respectively). Conclusions: our study suggests that the use of fluorescence bronchoscopy in addition to conventional white-light examination could greatly enhance the detection and localization of preinvasive bronchial lesions in patients with sputum cytology suspicious or positive for malignancy.

The Role of Endoscopic Techniques, Laser-Induced Fluorescence Endoscopy, and Endobronchial Ultrasonography in Choice of Appropriate Therapy for Bronchial Cancer

Laser-induced fluorescence endoscopy (LIFE) is useful in detecting precancerous lesions, and endobronchial ultrasonography (EBUS) is useful in the determination of the depth of tumor invasion into the bronchial wall. We conducted a clinical trial to determine the efficacy of assessment with a combination of LIFE and EBUS in patients with intraluminal lung cancer. We performed conventional white light bronchoscopy (WLB) followed by LIFE in 54 patients, and 67 samples from sites of suspected lesions were taken for biopsy. If an endobronchial tumor was detected, EBUS was performed. We could detect 29 lesions (metaplasia, 17; moderate dysplasia, 1; carcinoma in situ, 1; invasive carcinoma, 10) with WLB and LIFE; specifically, 12 lesions were detected when LIFE was used in addition to WLB (metaplasia, 9; moderate dysplasia, 1; carcinoma in situ, 1; invasive carcinoma, 1). Six patients were selected for EBUS to be evaluated for the depth of tumor invasion. Two patients with early cancer lesions, which were restricted within the mucosa and submucosa but not outside the cartilage, were considered candidates for photodynamic therapy, 3 patients with invasive cancer were candidates for surgery, and 1 patient for chemoradiotherapy. These patients were treated successfully. The assessment of an endobronchial tumor with the combination of LIFE and EBUS proved to be useful in decision making for the type of therapy.

Detection and localization of early lung cancer by fluorescence bronchoscopy

BACKGROUND Curative therapy is available for patients with Stage 0 lung carcinoma, with a >90% 5-year survival rate. Promising chemopreventive agents also are under investigation currently to reduce the risk of lung carcinoma in high risk populations. However, preinvasive bronchial lesions (moderate to severe dysplasia and carcinoma in situ) are very small and thin. They are difficult to localize by conventional white-light bronchoscopy. Fluorescence bronchoscopy is a new diagnostic tool for the detection of these preinvasive lesions. METHODS The data on the use of fluorescence bronchoscopy to detect and localize preinvasive lesions in current heavy smokers and in former smokers at the British Columbia Cancer Agency as well as the worldwide experience cited in MEDLINE, Index Medicus, and Deutsches Institut fur Medizinische Dokumentation und Information (Cologne, Germany) comparing white-light and fluorescence bronchoscopy using the lung imaging fluorescence endoscope (LIFE)-Lung device (Xillix Technologies Corp., Richmond, British Columbia, Canada) were reviewed. RESULTS Among current heavy smokers and former smokers with sputum atypia, the prevalence of carcinoma in situ was 1.6%. Moderate or severe dysplasia was found in another 19%. The preinvasive lesions were found to be small: 55% measured ≤1.5 mm in greatest dimension. Over 1000 cases have been reported in the literature between 1994 and 1999. Overall, 40% of the preinvasive lesions were detected by white-light bronchoscopy alone. The addition of fluorescence bronchoscopy increased the detection rate to an average of 80%. CONCLUSIONS Preinvasive lesions, especially dysplastic lesions, are small. They are difficult to detect and localize by white-light bronchoscopy. Fluorescence bronchoscopy improves the detection rate. It is an important part of the armamentarium in the overall management of early lung cancer. Cancer 2000;89:2468–73. © 2000 American Cancer Society.

Detection and localization of early lung cancer by fluorescence bronchoscopy.

Curative therapy is available for patients with Stage 0 lung carcinoma, with a >90% 5-year survival rate. Promising chemopreventive agents also are under investigation currently to reduce the risk of lung carcinoma in high risk populations. However, preinvasive bronchial lesions (moderate to severe dysplasia and carcinoma in situ) are very small and thin. They are difficult to localize by conventional white-light bronchoscopy. Fluorescence bronchoscopy is a new diagnostic tool for the detection of these preinvasive lesions. The data on the use of fluorescence bronchoscopy to detect and localize preinvasive lesions in current heavy smokers and in former smokers at the British Columbia Cancer Agency as well as the worldwide experience cited in MEDLINE, Index Medicus, and Deutsches Institut fur Medizinische Dokumentation und Information (Cologne, Germany) comparing white-light and fluorescence bronchoscopy using the lung imaging fluorescence endoscope (LIFE)-Lung device (Xillix Technologies Corp., Richmond, British Columbia, Canada) were reviewed. Among current heavy smokers and former smokers with sputum atypia, the prevalence of carcinoma in situ was 1.6%. Moderate or severe dysplasia was found in another 19%. The preinvasive lesions were found to be small: 55% measured < or = 1.5 mm in greatest dimension. Over 1000 cases have been reported in the literature between 1994 and 1999. Overall, 40% of the preinvasive lesions were detected by white-light bronchoscopy alone. The addition of fluorescence bronchoscopy increased the detection rate to an average of 80%. Preinvasive lesions, especially dysplastic lesions, are small. They are difficult to detect and localize by white-light bronchoscopy. Fluorescence bronchoscopy improves the detection rate. It is an important part of the armamentarium in the overall management of early lung cancer.

Detection of Bronchial Neoplasia in Uranium Miners by Autofluorescence Endoscopy (SAFE‐1000)

The increase in the detection rate for premalignant changes of bronchial epithelium was studied in 56 symptom-free volunteers from the risk group of Czech uranium miners (mean age 50.69 years, mean WLM 21.06 (1 Working Level Month is equal to the absorption of latent energy of 2.08 × 10–5 J/m3 in one month, i.e. 170 working hours)) by the additional employment of the System of Autofluorescence Endoscopy (SAFE-1000 Pentax) to conventional white-light bronchoscopy, comparing results with those of bronchial biopsy histopathology examination. Histopathology using hematoxylin and eosin staining confirmed intraepithelial neoplasias in 15 areas in 10 persons. White-light bronchoscopy sensitivity was 21.05%, and specificity 93.7% which an autofluorescence bronchoscopy sensitivity was 78.95% and specificity 81.89%.