Autofluorescence bronchoscopy with white light bronchoscopy compared with white light bronchoscopy alone for the detection of precancerous lesions:: a European randomised controlled multicentre trial

被引:141
作者
Häussinger, K
Becker, H
Stanzel, F
Kreuzer, A
Schmidt, B
Strausz, J
Cavaliere, S
Herth, F
Kohlhäufl, M
Müller, KM
Huber, RM
Pichlmeier, U
Bolliger, CT
机构
[1] Asklepios Fachkliniken Munchen Gauting, Ctr Resp Med & Thorac Surg, D-82131 Gauting, Germany
[2] Thoraxklin Heidelberg, Dept Interdisciplinary Endoscopy, D-69126 Heidelberg, Germany
[3] Pneumol Zentrum, Interne Abt Bronchol, A-1145 Vienna, Austria
[4] Schwerpunkt Pneumol Ch Witt, Med Klin, D-10117 Berlin, Germany
[5] Pulmonol Inst Torokbalint, H-2045 Munkacsy, Hungary
[6] Spedali Civili Brescia, Ctr Endoscopia & Laserterapia Apparato Resp, I-25123 Brescia, Italy
[7] Berufsgenossenschaftliche Kliniken Bergmannsheil, Inst Pathol, D-44702 Bochum, Germany
[8] Univ Munich, Klinikum Innenstadt, D-80336 Munich, Germany
[9] Univ Hamburg, Inst Med Biometry & Epidemiol, D-20246 Hamburg, Germany
[10] Univ Basel Hosp, Dept Internal Med, Div Resp, CH-4031 Basel, Switzerland
[11] Univ Stellenbosch, Cape Town, South Africa
关键词
D O I
10.1136/thx.2005.041475
中图分类号
R56 [呼吸系及胸部疾病];
学科分类号
摘要
Background: The potential of autofluorescence bronchoscopy (AFB) to detect precancerous lesions in the central airways and its role in lung cancer screening is uncertain. A study was undertaken to evaluate the prevalence of moderate/severe dysplasia (dysplasia II-III) and carcinoma in situ (CIS) using a newly developed AFB system in comparison with conventional white light bronchoscopy (WLB) alone. Methods: In a prospective randomised multicentre trial, smokers >= 40 years of age (>= 20 pack-years) were stratified into four different risk groups and investigated with either WLB+AFB (arm A) or WLB alone (arm B). Results: 1173 patients (916 men) of mean age 58.7 years were included. Overall (arms A and B), preinvasive lesions (dysplasia II-III and CIS) were detected in 3.9% of the patients. The prevalence of patients with preinvasive lesions in the WLB arm was 2.7% compared with 5.1% in the WLB+AFB arm (p = 0.037). For patients with dysplasia II-III, WLB+AFB increased the detection rate by a factor of 2.1 (p = 0.03), while for CIS the factor was only 1.24 (p = 0.75). The biopsy based sensitivity of WLB alone and WLB+AFB for detecting dysplasia II-III and CIS was 57.9% compared with 82.3% (1.42-fold increase). The corresponding specificity was 62.1% compared with 58.4% (0.94-fold decrease). Conclusions: This first randomised study of AFB showed that the combination of WLB+AFB was significantly superior to WLB alone in detecting preneoplastic lesions. Our findings do not support the general use of AFB as a screening tool for lung cancer, but suggest that it may be of use in certain groups. The precise indications await further study.
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页码:496 / 503
页数:8
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