Detection and localization of early lung cancer by fluorescence bronchoscopy

BACKGROUND. Curative therapy is available for patients with Stage 0 lung ca rcinoma, with a >90% 5-year survival rate. Promising chemopreventive agents also are under investigation currently to reduce the risk of lung carcinom a in high risk populations. However, preinvasive bronchial lesions (moderat e to severe dysplasia and carcinoma in situ) are very small and thin. They are difficult to localize by conventional white-light bronchoscopy. Fluores cence bronchoscopy is a new diagnostic tool for the detection of these prei nvasive lesions. METHODS. The data on the use of fluorescence bronchoscopy to detect and loc alize preinvasive lesions in current heavy smokers and in former smokers at the British Columbia Cancer Agency as well as the worldwide experience cit ed in MEDLINE, Index Medicus, and Deutsches Institut fur Medizinische Dokum entation und Information (Cologne, Germany) comparing white-light and fluor escence bronchoscopy using the lung imaging fluorescence endoscope (LIFE)-L ung device (Xillix Technologies Corp., Richmond, British Columbia, Canada) were reviewed. RESULTS. Among current heavy smokers and former smokers with sputum atypia, the prevalence of carcinoma in situ was 1.6%. Moderate or severe dysplasia was found in another 19%. The preinvasive lesions were found to be small: 55% measured less than or equal to1.5 mm in greatest dimension. Over 1000 c ases have been reported in the literature between 1994 and 1999. Overall, 4 0% of the preinvasive lesions were detected by white-light bronchoscopy alo ne. The addition of fluorescence bronchoscopy increased the detection rate to an average of 80%. CONCLUSIONS. Preinvasive lesions, especially dysplastic lesions, are small. They are difficult to detect and localize by white-light bronchoscopy. Flu orescence bronchoscopy improves the detection rate. It is an important part of the armamentarium in the overall management of early lung cancer. Cance r 2000;89:2468-73. (C) 2000 American Cancer Society.