A comparison of autofluorescence bronchoscopy and white light bronchoscopy in detection of lung cancer and preneoplastic lesions: a meta-analysis

Introduction: It is known that autofluorescence bronchoscopy (AFB) has limited value in detection of lung cancer and preneoplastic lesions. Though a substantial number of studies have evaluated the diagnostic yield of AFB, the variable estimates limited the ability to accurately assess its test performance and future role in clinical practice. The clinical utility of AFB has never been supported by a meta-analysis due to the inconsistent characteristics in some of studies. A meta-analysis was performed to re-examine the diagnostic efficiency of AFB compared with white light bronchoscopy (WLB).

Methods: Search of both MEDLINE and EMBASE database up to June 2009 was conducted and hand search was performed against the extracted reference list for relevancy. Included studies had to have a conclusive histology as diagnostic standard, and provided sufficient data to construct a 2X2 table for assessing the diagnostic yield of AFB for detection of lung cancer and preneoplastic lesions. After examining the source of variation, pooled sensitivity and specificity of AFB were estimated using a bivariate random-effects regressing model and compared with that of WLB.

Results: Of 439 publications, 14 studies, providing 15 sets of data, were suitable for analysis. The pooled sensitivity and specificity of AFB and WLB were 0.90 (95% CI 0.84-0.93) and 0.56 (95% CI 0.45-0.66), 0.66 (95% CI 0.58-0.73) and 0.69 (95% CI 0.57-0.79). The contribution of differences in excitation light source, histological criteria and biopsy strategy was not counted as a covariate.

Conclusions: The result indicated that AFB was superior to conventional WLB in detecting lung cancer and preneoplastic lesions.