A comparison of autofluorescence bronchoscopy and white light bronchoscopy in detection of lung cancer and preneoplastic lesions: A meta-analysis
Introduction
The prognosis of lung cancer strongly depends on the stage of disease at diagnosis. According to the theory of stepwise progression of carcinogenesis, early detection of preinvasive lesions, such as moderate or severe dysplasia, carcinoma in situ, and subsequently prompt surgical resection or endobronchial treatment will provide the patients with the best chance of survival and conservation of lung function. It was reported that five-year survival rate for patients treated for preinvasive (stage 0) lung cancer was greater than 90% [1]. Even for patients with invasive form of the cancer, the detection of synchronous lesions and identification of the extension of the tumor may lead to important changes in management plan [2], [3], [4]. This undoubtedly indicates the needs for early diagnosis of lung cancer in a preclinical stage. Unfortunately, the preinvasive lesions are superficial and minute in size [1], [5]. Therefore, the early detection of lung cancer presents a great challenge in clinical practice even for experienced bronchoscopist.
The difference in the intensity of autofluorescence between normal and neoplastic lesions has been reported as early as 1965 [6]. The first AFB was approved by US FDA in 1996, employing a helium-cadmium laser as excitation light source [7]. And a pseudo-color image based on autofluorescence and reflected light was used to delineate the abnormal area. As the technology improved, different systems have been developed, most using less expensive Xenon light source and a light filter [8], [9], [10]. Nowadays, AFB has become increasingly available and widely used for detection of preneoplastic lesions and lung cancer, resulting in improved appropriate sampling.
Up to recently, a number of studies have investigated the diagnostic yield of AFB and compared it with that of WLB. However, the estimates of sensitivity and specificity varied between reports, which inevitably limited the ability to accurately evaluate its test performance and future role in clinical practice [8], [9], [11], [12], [13], [14], [15], [16], [17], [18], [19], [20], [21], [22]. And to the current authors’ knowledge, the utility of AFB has never been supported by a meta-analysis based on all quantitative evidence. The primary endpoint of this study was to assess the diagnostic yield of AFB for detection of lung cancer and preneoplastic lesions. The second endpoint was to compare the test performance of AFB and WLB.
Section snippets
Data source and searches
We performed an evaluating search of two online databases to identify studies on comparing the diagnostic yields of AFB and WLB for identification of lung cancer and preneoplastic lesions. Sources were articles in MEDLINE and EMBASE published up to June 2009, no start date limit was applied. The search strategy included (“fluorescence” OR “fluorescence imaging”) combined with “bronchoscopy”. Search filters that often returned irrelevant studies and unlikely to decrease the number of articles to
Identification of studies and study quality
The details of study identification along with the inclusion and exclusion were shown in Fig. 1. Of the 439 references identified, 117 potentially relevant citations were selected. In 31 studies relevant to diagnostic yield of AFB, 19 were excluded, mainly due to trial design or failure to report outcome variables of interest, and 2 additional studies identified by hand search (see text documents, Supplemental Digital Content 1, which contains the studies excluded from the meta-analysis). A
Discussion
In this meta-analysis of 14 studies, the pooled sensitivity of AFB was 0.9, which is compared favorably with WLB. The pooled specificity was 0.56, lower than that of WLB. The high sensitivity and low specificity are commensurate with other imaging modalities, such as CT in the diagnosis of small malignant lung nodule [26]. It is worthwhile considering the possibility of making a preinvasive cancer diagnosis without additional risk.
As a routine study design, WLB was first carried out, and areas
Conflict of interest statement
All authors have none declared.
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