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Autofluorescence bronchoscopy with white light bronchoscopy compared with white light bronchoscopy alone for the detection of precancerous lesions: a European randomised controlled multicentre trial
  1. K Häußinger1,
  2. H Becker2,
  3. F Stanzel1,
  4. A Kreuzer3,
  5. B Schmidt4,
  6. J Strausz5,
  7. S Cavaliere6,
  8. F Herth2,
  9. M Kohlhäufl1,
  10. K-M Müller7,
  11. R-M Huber8,
  12. U Pichlmeier9,
  13. Ch T Bolliger10
  1. 1Center for Respiratory Medicine and Thoracic Surgery, Asklepios Fachkliniken München-Gauting, D-82131 Gauting, Germany
  2. 2Department of Interdisciplinary Endoscopy, Thoraxklinik Heidelberg, D-69126 Heidelberg, Germany
  3. 3Pneumologisches Zentrum, Interne Abteilung Bronchologie, A-1145 Wien, Austria
  4. 4Schwerpunkt Pneumologie (Ch. Witt), Medizinische Klinik, Charité Campus Mitte, D-10117 Berlin, Germany
  5. 5Pulmonological Institute Törökbálint, H-2045 Munkácsy Mihály u. 70, Hungary
  6. 6Centro di Endoscopia e Laserterapia dell Apparato Respiratorio, Spedali Civili di Brescia, I-25123 Brescia, Italy
  7. 7Institut für Pathologie, Berufsgenossenschaftliche Kliniken Bergmannsheil, D-44702 Bochum, Germany
  8. 8Pneumologie, Klinikum der Universität München-Innenstadt, D-80336 Munich, Germany
  9. 9University of Hamburg, Institute of Medical Biometry and Epidemiology, D-20246 Hamburg, Germany
  10. 10Respiratory Division, Departement of Internal Medicine, University Hospital, CH-4031 Basel, Switzerland and University of Stellenbosch, Cape Town, South Africa
  1. Correspondence to:
    Professor K Häußinger
    Center for Respiratory Medicine and Thoracic Surgery, Asklepios Fachkliniken München-Gauting, Robert-Koch-Allee 2, D-82131 Gauting, Germany; k.haeussingerasklepios.com

Abstract

Background: The potential of autofluorescence bronchoscopy (AFB) to detect precancerous lesions in the central airways and its role in lung cancer screening is uncertain. A study was undertaken to evaluate the prevalence of moderate/severe dysplasia (dysplasia II–III) and carcinoma in situ (CIS) using a newly developed AFB system in comparison with conventional white light bronchoscopy (WLB) alone.

Methods: In a prospective randomised multicentre trial, smokers ⩾40 years of age (⩾20 pack-years) were stratified into four different risk groups and investigated with either WLB+AFB (arm A) or WLB alone (arm B).

Results: 1173 patients (916 men) of mean age 58.7 years were included. Overall (arms A and B), preinvasive lesions (dysplasia II–III and CIS) were detected in 3.9% of the patients. The prevalence of patients with preinvasive lesions in the WLB arm was 2.7% compared with 5.1% in the WLB+AFB arm (p = 0.037). For patients with dysplasia II–III, WLB+AFB increased the detection rate by a factor of 2.1 (p = 0.03), while for CIS the factor was only 1.24 (p = 0.75). The biopsy based sensitivity of WLB alone and WLB+AFB for detecting dysplasia II–III and CIS was 57.9% compared with 82.3% (1.42-fold increase). The corresponding specificity was 62.1% compared with 58.4% (0.94-fold decrease).

Conclusions: This first randomised study of AFB showed that the combination of WLB+AFB was significantly superior to WLB alone in detecting preneoplastic lesions. Our findings do not support the general use of AFB as a screening tool for lung cancer, but suggest that it may be of use in certain groups. The precise indications await further study.

  • AFB, autofluorescence bronchoscopy
  • CIS, carcinoma in situ
  • WLB, white light bronchoscopy
  • white light bronchoscopy
  • autofluorescence bronchoscopy
  • lung cancer
  • preinvasive carcinoma
  • screening
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Footnotes

  • All authors besides UP and KMM were responsible for patient recruitment, performing the bronchoscopies, data capturing, and analysis of the overall results. Statistical analysis was done by UP and pathological analysis by KMM. KH, MK and ChTB wrote the paper.

  • Organisation (meetings of organisers and participants), collection of data, work up of pathology specimens, and some technical equipment (bronchoscopes and D-light devices) were supported by Karl Storz GmbH & Co KG, Mittelstr. 8, 78532 Tuttlingen, Germany. There was no other funding source and no financial support for the authors or investigators.

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