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BACKGROUND Curative therapy is available for patients with Stage 0 lung carcinoma, with a >90% 5‐year survival rate. Promising chemopreventive agents also are under investigation currently to reduce the risk of lung carcinoma in high risk populations. However, preinvasive bronchial lesions (moderate to severe dysplasia and carcinoma in situ) are very small and thin. They are difficult to localize by conventional white‐light bronchoscopy. Fluorescence bronchoscopy is a new diagnostic tool for the detection of these preinvasive lesions. METHODS The data on the use of fluorescence bronchoscopy to detect and localize preinvasive lesions in current heavy smokers and in former smokers at the British Columbia Cancer Agency as well as the worldwide experience cited in MEDLINE, Index Medicus, and Deutsches Institut fur Medizinische Dokumentation und Information (Cologne, Germany) comparing white‐light and fluorescence bronchoscopy using the lung imaging fluorescence endoscope (LIFE)‐Lung device (Xillix Technologies Corp., Richmond, British Columbia, Canada) were reviewed. RESULTS Among current heavy smokers and former smokers with sputum atypia, the prevalence of carcinoma in situ was 1.6%. Moderate or severe dysplasia was found in another 19%. The preinvasive lesions were found to be small: 55% measured ≤1.5 mm in greatest dimension. Over 1000 cases have been reported in the literature between 1994 and 1999. Overall, 40% of the preinvasive lesions were detected by white‐light bronchoscopy alone. The addition of fluorescence bronchoscopy increased the detection rate to an average of 80%. CONCLUSIONS Preinvasive lesions, especially dysplastic lesions, are small. They are difficult to detect and localize by white‐light bronchoscopy. Fluorescence bronchoscopy improves the detection rate. It is an important part of the armamentarium in the overall management of early lung cancer. Cancer 2000;89:2468–73. © 2000 American Cancer Society.

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The utility of autofluorescence imaging for early lung cancer detection has been previously demonstrated. The aim of this work is to extend the use of real‐time autofluorescence imaging to the early cancer detection in the esophagus, stomach, and colon. A prototype fluorescence imaging system for the gastrointestinal (GI) tract was developed which produces real‐time video images of tissue autofluorescence. It consists of a filtered mercury arc lamp light source, two intensified charge coupled device (ICCD) cameras, a fiber optic endoscope, and a computer‐based control console. The system is capable of working with three different imaging modalities: (1) conventional white light imaging mode; (2) light induced fluorescence (LIF) imaging mode based on the fluorescence imaging of two wavelength bands (green and red); and (3) light induced fluorescence and reflectance (LIFR) imaging mode based on the combination of a green band fluorescence image and a red–near‐IR reflectance image. The imaging wavelength bands were selected based on in vivo fluorescence spectroscopic studies. The fluorescence images (both LIF image and LIFR image) clearly delineate the abnormal tissue areas for biopsy. Early cancer sites are better visualized under fluorescence imaging than under conventional white light examination. Initial clinical tests demonstrated the usefulness of the imaging prototype system for early cancer detection in the GI tract.