Localization of bronchial intraepithelial neoplastic lesions by fluorescence bronchoscopy

Stephen Lam, Timothy Kennedy, Michael Unger, York E. Miller, David Gelmont, Valerie Rusch, Bruce Gipe, David Howard, Jean C. LeRiche, Andrew Coldman, Adi F. Gazdar

Research output: Contribution to journalArticle

515 Citations (Scopus)

Abstract

Background: In the treatment of lung cancer, the best outcome is achieved when the lesion is discovered in the intraepithelial (preinvasive) stage. However, intraepithelial neoplastic lesions are difficult to localize by conventional white-light bronchoscopy (WLB). Objective: To determine if autofluorescence bronchoscopy, when used as an adjunct to WLB, could improve the bronchoscopist's ability to locate and remove biopsy specimens from areas suspicious of intraepithelial neoplasia as compared with WLB alone. Method: A multicenter clinical trial was conducted in seven institutions in the United States and Canada. WLB followed by fluorescence examination with the light- induced fluorescence endoscopy (LIFE) device was performed in 173 subjects known or suspected to have lung cancer. Biopsy specimens were taken from all areas suspicious of moderate dysplasia or worse on WLB and/or LIFE examination. In addition, random biopsy specimens were also taken from other parts of the bronchial tree. Results: The relative sensitivity of WLB+LIFE vs WLB alone was 6.3 for intraepithelial neoplastic lesions and 2.71 when invasive carcinomas were also included. The positive predictive value was 0.33 and 0.39 and the negative predictive value was 0.89 and 0.83, respectively, for WLB+LIFE and WLB alone. Conclusion: Autofluorescence bronchoscopy, when used as an adjunct to standard WLB, enhances the bronchoscopist's ability to localize small neoplastic lesions, especially intraepithelial lesions that may have significant implication in the management of lung cancer in the future.

Original languageEnglish (US)
Pages (from-to)696-702
Number of pages7
JournalChest
Volume113
Issue number3
StatePublished - 1998

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Bronchoscopy
Fluorescence
Light
Endoscopy
Lung Neoplasms
Biopsy
Photophobia
Multicenter Studies
Canada
Clinical Trials

Keywords

  • Autofluorescence
  • Bronchoscopy
  • Early detection
  • Lung neoplasm

ASJC Scopus subject areas

  • Pulmonary and Respiratory Medicine

Cite this

Lam, S., Kennedy, T., Unger, M., Miller, Y. E., Gelmont, D., Rusch, V., ... Gazdar, A. F. (1998). Localization of bronchial intraepithelial neoplastic lesions by fluorescence bronchoscopy. Chest, 113(3), 696-702.

Localization of bronchial intraepithelial neoplastic lesions by fluorescence bronchoscopy. / Lam, Stephen; Kennedy, Timothy; Unger, Michael; Miller, York E.; Gelmont, David; Rusch, Valerie; Gipe, Bruce; Howard, David; LeRiche, Jean C.; Coldman, Andrew; Gazdar, Adi F.

In: Chest, Vol. 113, No. 3, 1998, p. 696-702.

Research output: Contribution to journalArticle

Lam, S, Kennedy, T, Unger, M, Miller, YE, Gelmont, D, Rusch, V, Gipe, B, Howard, D, LeRiche, JC, Coldman, A & Gazdar, AF 1998, 'Localization of bronchial intraepithelial neoplastic lesions by fluorescence bronchoscopy', Chest, vol. 113, no. 3, pp. 696-702.
Lam S, Kennedy T, Unger M, Miller YE, Gelmont D, Rusch V et al. Localization of bronchial intraepithelial neoplastic lesions by fluorescence bronchoscopy. Chest. 1998;113(3):696-702.
Lam, Stephen ; Kennedy, Timothy ; Unger, Michael ; Miller, York E. ; Gelmont, David ; Rusch, Valerie ; Gipe, Bruce ; Howard, David ; LeRiche, Jean C. ; Coldman, Andrew ; Gazdar, Adi F. / Localization of bronchial intraepithelial neoplastic lesions by fluorescence bronchoscopy. In: Chest. 1998 ; Vol. 113, No. 3. pp. 696-702.
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AU - Kennedy, Timothy

AU - Unger, Michael

AU - Miller, York E.

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AU - Gipe, Bruce

AU - Howard, David

AU - LeRiche, Jean C.

AU - Coldman, Andrew

AU - Gazdar, Adi F.

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N2 - Background: In the treatment of lung cancer, the best outcome is achieved when the lesion is discovered in the intraepithelial (preinvasive) stage. However, intraepithelial neoplastic lesions are difficult to localize by conventional white-light bronchoscopy (WLB). Objective: To determine if autofluorescence bronchoscopy, when used as an adjunct to WLB, could improve the bronchoscopist's ability to locate and remove biopsy specimens from areas suspicious of intraepithelial neoplasia as compared with WLB alone. Method: A multicenter clinical trial was conducted in seven institutions in the United States and Canada. WLB followed by fluorescence examination with the light- induced fluorescence endoscopy (LIFE) device was performed in 173 subjects known or suspected to have lung cancer. Biopsy specimens were taken from all areas suspicious of moderate dysplasia or worse on WLB and/or LIFE examination. In addition, random biopsy specimens were also taken from other parts of the bronchial tree. Results: The relative sensitivity of WLB+LIFE vs WLB alone was 6.3 for intraepithelial neoplastic lesions and 2.71 when invasive carcinomas were also included. The positive predictive value was 0.33 and 0.39 and the negative predictive value was 0.89 and 0.83, respectively, for WLB+LIFE and WLB alone. Conclusion: Autofluorescence bronchoscopy, when used as an adjunct to standard WLB, enhances the bronchoscopist's ability to localize small neoplastic lesions, especially intraepithelial lesions that may have significant implication in the management of lung cancer in the future.

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