Elsevier

Lung Cancer

Volume 25, Issue 3, September 1999, Pages 161-168
Lung Cancer

Detection of bronchial preneoplastic lesions and early lung cancer with fluorescence bronchoscopy: a study about its ambulatory feasibility under local anaesthesis

https://doi.org/10.1016/S0169-5002(99)00058-6Get rights and content

Abstract

Background: Autofluorescence bronchoscopy (AB) enhances the bronchoscopist’s ability to diagnose bronchial preneoplastic lesions and early cancer. We undertook a study to assess its feasibility and performance under local anaesthesia on a real ambulatory mode. Methods: Thirty-four consecutive patients at very high risk for lung cancer were prospectively studied by AB under local anaesthesia, without any sedation. Lidocaine doses, time, oxygen saturation, peak expiratory flow (PEF) and the number of cough episodes were measured. Continuous assessment of the respiratory sensation was obtained with a visual analog scale. A total of 172 biopsies were performed in abnormal and normal areas. Results: The procedure was long-lasting (mean±SD: 26.6±6.0 min), required high total doses of Lidocaine (660±107 mg) without any significant side effect, and was associated with significant decreases in O2 saturation from 98.5±1.4 to 96.1±2.5% and in PEF from 380±96 to 310±78 l/min. However, the cough counts were moderate and the majority of patients reported no respiratory discomfort. 62 hyperplasia, metaplasia, dysplasia and carcinoma in situ (CIS) were detected and the relative sensitivity of AB+white-light bronchoscopy (WLB) versus WLB alone was 3.75 for intraepithelial lesions corresponding to moderate dysplasia or worse. Conclusions: AB, a procedure that increases our ability to recognize preneoplastic lesions and early lung cancer, can be performed under local anaesthesia, without systemic sedation in patients at very high risk for lung cancer.

Introduction

The poor prognosis of lung cancer is mainly related to the fact that most often, diagnosis is made late in the natural history of the disease, at a stage when treatment is only rarely curative. Recently, a device called LIFE (Light Induced Fluorescence Endoscopy; Xillix LIFE Imaging System, Vancouver, Canada) that allows autofluorescence examination of the airways using a conventional flexible fiberoptic bronchoscope has been developed [1], [2]. This system is based on the observation that lung cancer tissue fluoresces less than normal tissue and allows thereby detection of premalignant lesions and carcinoma in situ (CIS) that may have a normal appearance during conventional white-light bronchoscopy (WLB) [1], [2], [3].

The widespread use of this system is however hindered, among other factors, by the fact that, at least in some centers, this peculiar bronchial examination is performed with systemic sedation or even under general anaesthesia for at least three reasons. Firstly, the whole procedure is long-lasting since autofluorescence examination is conventionally preceded by white-light examination of the airways and followed by biopsies of all the areas suspected of being preneoplastic lesions or CIS [1], [2]. Secondly, the procedure may be poorly tolerated under local anaesthesia since patients at high risk for lung cancer who are the usual candidates for this examination often show, at the same time, reduced lung function associated with chronic airflow obstruction [4] and/or previous resection of lung cancer [5]. And finally, cough induced traumatic lesions of the bronchial mucosa during endoscopy may disturb the interpretation of autofluorescence examination.

The main endpoint of the present study was, therefore, to assess whether autofluorescence bronchoscopy (AB) is feasible under local anaesthesia, on a real ambulatory mode, in a group of patients at high risk for lung cancer. As an additional endpoint, we wanted to assess in these conditions the performance of this tool in comparison to WLB.

Section snippets

Patients and methods

To be eligible for the study, patients had to have a previous history of lung cancer and/or a minimum smoking exposure of 30 cigarettes pack-years, both conditions known to be at high risk for lung cancer as previously defined [6]. Pulmonary function tests were required. No systemic sedation was permitted. All patients had to provide informed consent to the procedures as approved by the Human Studies Committee of the Institution.

Bronchoscopy (Olympus BF20D) was performed while the patient was

Results

Thirty-four consecutive patients (mean age: 59±11 years; 26 men and 8 women) were prospectively studied. All of them were at high risk for lung cancer. Clinical history included invasive lung cancer in 25 patients. These 25 patients included 17 patients evaluated for screening of a second primary tumour after curative treatment from a previous lung cancer by surgery (n=13) or chemotherapy (n=4) and 8 patients with a newly diagnosed non small cell lung cancer who were candidates for surgical

Discussion

The initial results of autofluorescence bronchoscopy were reported [1], [2], [3] as excellent for the detection of severe bronchial preneoplastic lesions (moderate dysplasia or worse) and radio-occult lung cancer. These data suggest that autofluorescence examination may be introduced for the detection of early lung cancer in asymptomatic patients at high risk for lung cancer and for delineating the endobronchial limits of neoplastic extension in patients who are candidates for lung cancer

Acknowledgements

We are indebted to Professor J. Metayer, Rouen (France) for kindly reviewing the biopsies, to M. Paesmans for help in statistical analysis and to C. Decoster for her technical assistance. This work was supported in part by a grant FNRS-Télévie No 9.4587.95. P. Vermylen is the recipient of a fellowship FNRS-Télévie No 7.4523.96. P. Vermylen and C. Roufosse are also supported by the Vésale Foundation, Saint-Pierre Hospital, Brussels, Belgium.

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