The Clinical Value Of Autofluorescence Bronchoscopy In Airway Lesion

ObjectiveTo preliminarily exprore the diagnostic value of autofluorescence bronchoscopy in lesions of the airway.MethodFrom January 2010 to January 2011, 50 patients underwent Pentax SAFE-3000 bronchoscopy using both the white light bronchoscopy (WLB) mode and autofluorescence bronchoscopy(AFB) mode. Biopsies of the affected regions and some nomal parts of the bronchial tree were taken for pathologic examination on WLB and/or AFB examination.ResultsA total of 141 biopsy specimens were taken. Of these, 5 were not evaluable. The final pathologic diagnosis for the remaining 136 biopsy specimens were as follows: normal /inflam- mation in 63; hyperplasia, metaplasia, low-grade dysplasia, moderate/severe dysplasia or carcinoma in 73. Biopsy specimens with normal/inflammation, were analyzed as one group (considered to be negative); and biopsy specimens with the diagnosis of hyperplasia, squamous metaplasia, low-grade dysplasia, moderate or severe dysplasia, carcinoma were analyzed as the other group (considered to be positive). This was then used as the standard to determine the diagnostic ability of the bronchoscopic procedures. The WLB detected 49 of 73 lesions, and the AFB detected 51. The sensitivities of the WLB and AFB were 67.1% and 69.9%, respectively, and the specificities were 71.2% and 68.3% , respectively. The WLB and AFB combined(WLB+AFB)detected 55 of 73 lesions. The sensitivity of WLB+AFB was 75.3%, and the specificities was 65.1%. The McNemar test was used for analysis of variance. Although the sensitivity of AFB (69.9%)was higer than that of WLB(67.1%), the difference was not statistically significant(P>0.05). The sensitivity of WLB and AFB combined was statistically significantly better than that of WLB, 75.3% versus 67.1% (P=0.031<0.05). Although the sensitivity of WLB+AFB(75.3%)was higer than that of AFB(69.9%), the difference was not statistically significant (P>0.05). The specificity of AFB was lower than that of WLB, 68.3% versus 71.2%, the difference was not statistically significant(P>0.05). Though the specificity of WLB+AFB was lower than that of WLB, 65.1% versus 71.2%, but the difference was not statistically significant(P>0.05).Then biopsy specimens were classified into 3 grades, patholog- y-I : Normal/inflammation; pathology-II: hyperplasia, metaplasia, low-grade dysplasia, moderate or severe dysplasia; pathology-III: carcinoma. We then determined the sensitivity for diagnosing leisions of pathology-II. The sensitivity of WLB and AFB combined(43.6%)was higer than that of WLB(28.1%), the difference was not statistically significant (P>0.05). Then we determined the sensitivity for diagnosing leisions of pathology-III. The sensitivity of WLB and AFB combined (100.0%)was higer than that of WLB(97.6%), the difference was not statistically significant (P>0.05).ConclusionThe sensitivity of WLB +AFB for detecting lesion of hyperplasia or worse was higer than WLB alone. Autofluorescence bronchoscopy may have significant implication in the management of airway lesion in the future.