[Autofluorescence bronchoscopy in early diagnosis of pulmonary carcinoma]

Autofluorescence bronchoscopy (AFB) has been proposed to widen traditional white light bronchoscopy (WLB) possibilities of early diagnosis of neoplastic and preneoplastic lesions of the tracheo-bronchial mucosa in high risk groups. The authors report their study on AFB with the aim of establishing its role in the early diagnosis of bronchogenic carcinoma and its positive predictive value (PPV) compared and associated to WLB.

From May 2002 to May 2004 we performed WLB and AFB in 213 patients (177 males, 36 females), mean age 63.7 years (range 18-84 years), who were divided into 2 main groups (group A: patients at risk for bronchogenic carcinoma, n=82; group B: patients to be operated on for bronchogenic carcinoma, n=131). In total, 237 WLB-AFB were performed (101 in group A, 136 in group B) and 77 biopsies for pathological examination.

The 2 tools (WLB and AFB) were concordant in 156 (66%) and discordant in 81 (34%) cases. Considering the biopsies performed, we obtained a PPV of 26% for lesions visible with WLB, of 40% for those visible with AFB, of 38% for those visible with the association of both. In group A, in 56 patients of the follow-up subgroup, we found 2 dysplastic areas and 1 carcinoma in situ. In group B there was a discordant extension of the pathologic area visible with WLB and with AFB in 30 cases which was positive in 18 of them at histological examination.

In our experience, AFB has revealed to be a valid tool for both early diagnosis of neoplastic recurrences or a second primary lung neoplasia in patients in follow-up after resection and preoperative evaluation of resection margins in patients candidate to surgery. More studies are needed to widen its indications in the early diagnosis in high risk groups, to improve its potentialities and optimize its learning curve in order to establish the procedural guide lines.