Japanese Journal of Clinical Oncology Advance Access published online on October 16, 2009
Japanese Journal of Clinical Oncology, doi:10.1093/jjco/hyp135
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© The Author (2009). Published by Oxford University Press. All rights reserved
Autofluorescence Imaging Videobrochoscopy Improves Assessment of Tumor Margins and Affects Therapeutic Strategy in Central Lung Cancer
1 Department for Interventional Pulmonology, Faculty of Medicine, Clinic for Pulmonary Oncology, Institute for Pulmonary Diseases of Vojvodina, University of Novi Sad, Sremska Kamencia, Serbia
2 Department for Multidisciplinary Endoscopy, Thoraxklinik, University of Heidelberg, Heidelberg, Germany
3 Faculty of Medicine, Institute for Cardiovascular Diseases of Vojvodina, University of Novi Sad
4 Faculty of Medicine, Department for Pathology, Institute for Pulmonary Diseases of Vojvodina, University of Novi Sad
5 Faculty of Medicine, Clinic for Thoracic Surgery, Institute for Pulmonary Diseases of Vojvodina, University of Novi Sad, Sremska Kamencia, Serbia
For reprints and all correspondence: Bojan Zaric, Department for Interventional Pulmonology, Faculty of Medicine, Clinic for Pulmonary Oncology, Institute for Pulmonary Diseases of Vojvodina, University of Novi Sad, Institutski put 4, 21204 Sremska Kamenica, Serbia. E-mail: bojanzaric{at}neobee.net
Received July 27, 2009; accepted September 7, 2009
Objective: Autofluorescence imaging (AFI) videobronchoscopy is a new endoscopic tool that improves visualization of neoplastic changes in the bronchial mucosa. The major aim of our study was to determine sensitivity and specificity of the technique in the assessment of tumor extent (margins). The secondary objective was to evaluate the possible effect of AFI on the change in therapeutic decisions of lung cancer treatment.
Methods: In this prospective trial, we enrolled 104 patients in whom we performed 624 targeted biopsies, 3 from the pathologically altered mucosa (red-brownish or magenta colored) and 3 from randomly picked normal areas. We were using the Olympus BF-F260 videobronchoscope and EVIS LUCERA system. White light videobronchoscopy (WLB) preceded AFI examination and biopsy collection. All biopsy specimens were examined by a pathologist blinded to bronchoscopy findings, and where applicable surgically resected specimens were examined.
Results: In 14.4% of the patients, AFI revealed a greater extent of the tumor than WLB, and in 11.5% that finding led to change in therapeutic decision (lesser or greater resection or avoidance of surgery). We found a significant correlation between tumor extent determined by AFI and changes in therapeutic decisions (P < 0.01). Sensitivity, specificity, positive predictive value and negative predictive value for AFI in the assessment of tumor extension were 93%, 92%, 92% and 93%, respectively. Corresponding results for WLB were 84%, 79%, 77% and 85%, respectively. Relative sensitivity of AFI is 1.11.
Conclusions: Our results confirm that AFI videobronchoscopy significantly improves the assessment of central lung cancer extension and influences the therapeutic strategy. This technique has greater sensitivity and specificity, in assessment of tumor margins, than WLB alone.
Key Words: autofluorescence bronchoscopy • bronchoscopy • biopsy • interventional pulmonology • lung cancer • videobronchoscopy • surgical treatment