Current indications and future perspective of fluorescence bronchoscopy: a review study

Area of Science:

• Pulmonology
• Oncology
• Medical Imaging

Background:

• Autofluorescence bronchoscopy (AFB) has been used since the 1990s for identifying pre-neoplastic and early neoplastic endobronchial lesions.
• Early detection of these lesions is crucial for improving lung cancer outcomes.

Purpose of the Study:

• To review current indications for AFB.
• To compare the sensitivity and specificity of AFB against white light bronchoscopy (WLB) for detecting pre- and early neoplastic lesions.

Main Methods:

• A literature search identified 62 eligible articles.
• Articles were categorized based on AFB's application: early neoplastic changes, bronchial changes in smokers, treatment monitoring, synchronous lesions, and lung cancer screening.
• Sensitivity and specificity data for AFB and WLB were analyzed.

Main Results:

• AFB demonstrated significantly higher sensitivity than WLB in identifying pre-neoplastic and early neoplastic lesions across all categories.
• WLB exhibited higher specificity compared to AFB.
• AFB's sensitivity advantage was most pronounced when pre- and early neoplastic lesions were more prevalent than invasive cancer.

Conclusions:

• AFB should be incorporated into routine investigations for suspected lung cancer patients.
• AFB is recommended for patients undergoing lung cancer surgery and post-treatment follow-up for early cancer detection or recurrence monitoring.
• AFB inclusion in lung cancer screening program protocols is suggested.