Postoperative fluorescence bronchoscopic surveillance in non-small cell lung cancer patients

Background. Second lung primaries occur at a rate of 1% to 3% per patient-y ear after complete resections for non-small cell lung carcinoma (NSCLC). Fl uorescence bronchoscopy appears to be a sensitive tool for surveillance of the tracheobronchial tree for early neoplasias. Methods. Patients who were disease-free after complete resection of a NSCLC were entered into a fluorescence bronchoscopy surveillance program, All su spicious lesions were biopsied along with two areas of normal mucosa to ser ve as negative controls. Results. A total of 73 fluorescence bronchoscopies were performed after con ventional bronchoscopy in 51 patients at a median of 13 months postresectio n. The majority (46 of 51) of patients had stage I or II NSCLC, whereas 10% (5 of 51) had stage IIIA. Three intraepithelial neoplasias and one invasiv e carcinoma were identified in 3 of 51 patients (6%), all current or former smokers. Of the four lesions identified, three were in the 20 patients wit h prior squamous cell carcinomas. No intraepithelial neoplasias were identi fied by white-light bronchoscopy, whereas two of three were detected by flu orescence examination. The one invasive cancer detected was apparent on bot h white-light and fluorescence bronchoscopic examinations. Conclusions. Surveillance with fluorescence bronchoscopy identified lesions in 6% of postoperative NSCLC patients thought to be disease-free. Patients with prior squamous cell carcinomas appear to be a population that may war rant future prospective study of postoperative fluorescence bronchoscopic s urveillance. (C) 2001 by The Society of Thoracic Surgeons.