Detection and localization of early lung cancer by fluorescence bronchoscopy

Abstract

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.

Chromosome 5p aberrations are early events in lung cancer: implication of glial cell line-derived neurotrophic factor in disease progression

“…Formalin-fixed paraffin-embedded lung CIS samples used in array CGH analysis were collected by fluorescent bronchoscopy as part of the Lung Health Study at the British Columbia Cancer Agency (Lam et al, 2000;McWilliams et al, 2002). Both fixed and frozen tissues were obtained from the archive of St Paul's Hospital, Vancouver and the Ontario Cancer Institute, Toronto.…”

Value of Autofluorescence Imaging Videobronchoscopy in Detecting Lung Cancers and Precancerous Lesions: A Review

“…In the past 3 decades, AFB has been applied to detect early-stage carcinomatous lesions through endoscopy workstation. 9,10 Several types of AFB systems have been designed, developed, and marketed, including the LIFE system (Xillix Technologies, Richmond, British Columbia, Canada), the D-Light system (Karl Storz, Tuttlingen, Germany), and the SAFE system (Pentax, Tokyo, Japan). In comparison with conventional WLB, these AFBs provide a much higher sensitivity, which is interesting and exciting, but at the same time, the specificity is lower, [11][12][13][14][15][16][17][18] which is, obviously, an important disadvantage.…”

Innovative molecular and imaging approaches for the detection of lung cancer and its precursor lesions

“…Localization of pre-invasive and early invasive lung cancer is difficult with white light bronchoscopy as less than 40% of carcinoma in situ is detectable (Woolner, 1983;Lam et al, 2000a). This clinical problem, combined with the improvement of medical endoscopes, light sources, optical fibres, and imaging and non-imaging detectors, have driven the development of autofluorescence bronchoscopy for the localization of early, pre-invasive lung cancer.…”

“…A second clinical prototype uses a filtered Xe lamp (blue light excitation). It has been investigated world-wide in over 1600 patients and is now a well established technique with twice the sensitivity of white light bronchoscopy in detection of these lesions on the average (sensitivity 80% vs 40%) (Lam et al, 2000a;Wagnieres et al, 2002). An example of a carcinoma in situ lesion localized by autofluorescence bronchoscopy in a high-risk smoker with atypical cells in the sputum is illustrated in Figure 1.…”