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Fluorescence Versus White-Light Bronchoscopy Rand.pdf

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Fluorescence Versus White-Light Bronchoscopy Rand

Fluorescence Versus White-Light Bronchoscopy for Detection of Preneoplastic Lesions: a Randomized Study Fred R. Hirsch, Sheila A. Prindiville, York E. Miller, Wilbur A. Franklin, Edward C. Dempsey, James R. Murphy, Paul A. Bunn, Jr., Timothy C. Kennedy Background: There are no currently approved methods for the screening and early detection of lung cancer. We com- pared the ability of conventional white-light bronchoscopy (WLB) and laser-induced fluorescence endoscopy (LIFE) to detect preneoplastic lung lesions in a randomized trial in which both the order of the procedures and the bronchos- copists were randomly assigned. Methods: The study in- cluded high-risk subjects enrolled because of a cigarette smoking history of at least 30 pack-years, an air-flow ob- struction, and either an abnormal sputum cytology (n = 48) or a previous or suspected lung cancer (n = 7). LIFE and WLB were performed on all patients. Biopsy specimens were assessed for histologic abnormalities, including the presence of angiogenic squamous dysplasia. All statistical tests were two-sided. Results: A total of 391 biopsy specimens were taken from the 55 patients. Thirty-two patients (58%; 95% confidence interval [CI] = 44% to 71%) had at least one biopsy with moderate or severe dysplasia, and 19 (59%; 95% CI = 41% to 76%) of these patients could be diagnosed based solely on the results of LIFE. LIFE was statistically signifi- cantly more sensitive than WLB for detecting moderate dys- plasia or worse (68.8% versus 21.9%, respectively) (differ- ence = 46.9%; 95% CI = 25% to 68%; P.001). The relative sensitivities (WLB = 1.0) were 3.1 (95% CI = 1.6 to 6.3) for LIFE and 3.7 (95% CI = 1.9 to 7.3) for LIFE and WLB combined. LIFE was less specific than WLB (69.6% versus 78.3%, respectively; P = .45), but the difference was not statistically significant. The relative specificities (WLB = 1.0) were 0.9 for LIFE (95% CI = 0.6 to 1.3) and 0.6 (95% CI = 0.4 to 1.0) for LIFE and WLB combined. The results we