Fluorescent bronchoscopy
Section snippets
Fluorescent bronchoscopy
Fluorescent bronchoscopy uses the observation that dysplastic tissue and areas of CIS demonstrate weaker green fluorescence than normal tissues when illuminated with blue light. Fluorescent properties of human tissues have been the object of scientific interest since the early 1920s [10]. Early attempts at endobronchial surveillance used fluorescent dyes. Current fluorescent bronchoscopy exploits the autofluorescence characteristics of premalignant and malignant lesions of the bronchial mucosa,
Bronchoscopic technique
Bronchoscopy is performed on an outpatient basis using local anesthesia with or without intravenous sedation. It is combined with a conventional WLB examination and adds approximately 15 minutes to the overall procedure time [15]. An Olympus BF20 (Olympus America, Melville, New York) is used. During a LIFE examination, areas of normal green fluorescence are labeled class I (normal), whereas areas of increased redness with indistinct borders are labeled class II (abnormal). Class III lesions
Prebronchoscopy risk stratification
The success of any screening program depends on the prescreening risk of cancer in the group being evaluated. Although 80% of lung cancers are attributed to smoking, less than 20% of smokers develop lung cancer in their lifetime. The yearly incidence of lung cancer in the general population of the United States is 0.05% to 0.09% [1]. Epidemiologic studies show that an increased risk of lung cancer is seen in patients who have more extensive smoking histories. Presence of chronic obstructive
Chemoprevention
Saccomanno observed in longitudinal studies that abnormal bronchial epithelial cell changes predated development of invasive lung cancer [19], [20]. It is now believed that lung cancers develop through a series of sequential morphologic changes from metaplasia to dysplasia to CIS before the development of invasive cancer. Bronchoscopic identification of these premalignant lesions can be used to identify patients for chemopreventative therapy or sequential monitoring. Longitudinal monitoring of
Clinical trials with lung imaging fluorescence endoscope bronchoscopy
A large experience with LIFE bronchoscopy has been reported in the literature. Generally, it attests to the improved sensitivity of LIFE bronchoscopy over standard WLB in detecting dysplasia and CIS. One study involving 173 high-risk patients from seven centers in the United States and Canada demonstrated that the combination of WLB and LIFE bronchoscopy improved clinicians' ability to detect premalignant and early-stage malignant bronchial lesions endoscopically [15]. In that group of
Lung imaging fluorescence endoscope bronchoscopy for cancer staging
A recent study found that LIFE bronchoscopy was useful in staging early endobronchial lesions and determining which lesions were amenable to endobronchial therapy as opposed to more invasive therapy [35]. Twenty-three patients who had radiologically occult tumors who were referred for endobronchial therapy were evaluated with LIFE bronchoscopy. On high-resolution CT scanning, radiologically apparent disease (lymph nodes or primary tumor) was detected in four patients. The remaining 19 patients
University of Pittsburgh experience
At the University of Pittsburgh, LIFE bronchoscopy was used to screen patients for the occurrence of second primary lung cancer following pulmonary resection for non–small-cell lung cancer between 1997 and 2002. The initial experience has been reported [37]. Ninety-five patients participated in the screening program. Fifty-five had resected adenocarcinomas and 40 had resected squamous cell carcinomas. The examination frequency was annually if no abnormalities were identified. Seventy-four
Future directions
The evolution of LIFE technology toward a more objective quantification of tissue fluorescence and the addition of other complementary endoscopic tools such as endobronchial ultrasound might improve the specificity of the technique, which would ultimately benefit patients by decreasing the number of biopsies performed and the time requirement for the examination. With an emphasis on screening and early diagnosis, clinicians might see more patients who have radiologically occult lesions who will
Acknowledgements
The authors would like to acknowledge the assistance of Jill Ireland in the preparation of this manuscript.
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