Fluorescence bronchoscopic surveillance after curative surgical resection for non-small-cell lung cancer

Background: Second lung primaries occur at a rate of up to 3% per patient-y ear after curative resection for non-small-cell lung carcinoma. Postresecti on patients are often poor candidates for further curative surgery because of their diminished pulmonary reserve. The aim of this study was to evaluat e the role of fluorescence bronchoscopy by using the Xillix(R) LIFE-tung Fl uorescence Endoscopy System(TM) to identify second lung primaries in patien ts who have had a previous curative resection of a non-small-cell lung canc er. Methods: Patients who had no evidence of disease status after resection of a non-small-cell lung cancer were identified from a prospectively collected data base and entered onto a fluorescence bronchoscopy surveillance protoc ol. All suspicious areas, as well as several areas of apparently normal muc osa, were sampled for biopsy. A single pathologist reviewed all biopsy spec imens, with 10% of biopsies re-reviewed, for quality control, by a second p ulmonary pathologist. Results: A total of 31 surveillance fluorescence bronchoscopies were perfor med on 15 patients after conventional bronchoscopy. Four intraepithelial ne oplasias or invasive carcinomas were identified in 3 (12%) of 25 patients s creened. The addition of the LIFE examination to conventional bronchoscopy increased the sensitivity of screening from 25.0% to 75.0%, which yielded a relative sensitivity of 300%? with a negative predictive value of .97. Conclusions: Use of postresection surveillance with fluorescence bronchosco py identified intraepithelial or invasive lesions in 12% of non-small-cell lung cancer patients, and the system was three times more sensitive than co nventional bronchoscopy to identify these early mucosal lesions. Fluorescen ce bronchoscopic surveillance of this high-risk, postresection population w ill help better define the true rate of occurrence and the natural history of second primaries and may assist in monitoring their response to newer, n oninvasive treatment methods, such as photodynamic therapy or chemopreventi ve agents, in future trials.