[Role of endobronchial endoscopic techniques in the detection of bronchial cancer]

The fiberoptic endoscopy remains the only technique available for the diagnosis of roentgenographically occult bronchial carcinomas. In this indication, its use is restricted to the exploration of the proximal part of the bronchial tree, and practically, to early detection of squamous cell carcinomas. To date, the cost and invasiveness of the endoscopic techniques imply that they cannot be used as a mass screening tool. However, prospective early lung cancer detection programs using fiberoptic endoscopy in a very high risk, selected population could be designed. Several research programs are currently conducted around the world to evaluate this strategy. The preliminary results of a prospective study conducted in Rouen University Hospital suggest that the use of new technologies such as fluorescence endoscopy in such programs might be useful to detect very early bronchial lesions, especially in smokers with heavy occupational exposure to asbestos. To date, the application of such programs to large populations is limited by the low availability and high cost of the fluorescence endoscopy technique. More precise knowledge on risk factors associated with early proximal lung cancer lesions and a strict evaluation of the risk/benefit ratio of the endoscopy strategy are also needed.