Diagnostic Value Of Autofluorescence Bronchoscopy For Suspected Bronchogenic Carcinoma

BackgroundAccording to the 2016 International Cancer Research Center and the 2017 National Cancer Research Center,lung cancer incidence and mortality rank first in malignant tumors and increase year by year.It has become the number one killer of threats to human health in international and domestic malignancies.At present,the treatment of lung cancer mainly includes surgery,chemotherapy,radiotherapy and targeted therapy.Surgical resection is still the most effective treatment at present.The 5-year survival rate of locally diagnosed surgically resectable local tumors can exceed 70%,and the cure rate of in situ carcinoma and intratracheal microinvasive carcinoma can be as high as 90%.Because the clinical manifestations of lung cancer are not specific,most lung cancers are diagnosed at an advanced stage and lose the chance of surgery,and the overall prognosis is poor.Therefore,early diagnosis and treatment of lung cancer is the key.Early detection of lung cancer is limited,early detection of lung cancer can be achieved by analyzing biomarkers from tissue samples,in the respiratory tract such as sputum,saliva,nasal/respiratory epithelial cells and exhaled air clotting or through peripheral organisms Fluids such as blood,serum and urine have a low positive rate.At present,it has been confirmed in the literature that low-dose computed tomography(LDCT)for cancer screening in patients with high risk of lung cancer can reduce mortality by 20%,but has a high rate of missed diagnosis of central small lumen lesions.Some scholars have studied new screening tools,such as the detection of microRNAs(miRNAs)in sputum or blood,can complement CT to diagnose lung cancer-specific low deficiency,but need multi-center clinical trial for further verification.Traditional white light bronchoscopy has been widely used in clinical practice,and plays a decisive role in the diagnosis and treatment of respiratory diseases,especially bronchial lesions.Bronchoscopic examination can be used to direct bronchial mucosal lesions to guide biopsy,but early lung cancer histopathological changes are molecular levels,involving only a few layers of cells,difficult to be found by the naked eye under WLB.Some scholars believe that,even experienced bronchoscopy experts can only diagnose 29% of central type carcinoma in situ,therefore,how to improve the detection rate of early lung cancer is still a hot and difficult point at home and abroad.Autofluorescence bronchoscopy is a new technique for the examination of mucosal lesions based on WLB.It mainly uses the fluorescence characteristics of tissues to analyze the fluorescence spectra of normal tissues,precancerous lesions and tumor tissues.The difference between normal and abnormal lesions,guiding effective biopsy,has a certain significance for improving the detection rate of early lung cancer.Since the development of autofluorescence bronchoscopy for 20 years,it has been widely used in clinical practice.The AFI system is a new type of fluorescent bronchoscope system developed in Japan in recent years.It can be switched between white light and fluoroscopic mode,and it is easy to operate.There are many researches on the clinical application of fluoroscopy.Domestic research has confirmed its effectiveness in the diagnosis of early lung cancer.However,there are few large-scale studies on the diagnostic value of AFB for different pathological forms of lung cancer under WLB.Check in white light mode first,then perform fluorescence mode check.To analyze the relationship between pathological changes and pathological findings under white light microscope and fluoroscopy,and to explore the superiority of autofluorescence bronchoscopy,so as to better guide the early diagnosis of lung cancer.ObjectiveTo explore the diagnostic value of autofluorescence bronchoscopy in patients with suspected bronchogenic carcinoma.MethodFrom January 2017 to December 2017,the bronchoscopy room of the First Affiliated Hospital of Zhengzhou University was diagnosed as bronchial lung cancer by chest CT or sputum cytology.According to the inclusion criteria,1026 patients were enrolled in the self-fluorescent bronchus.Microscopic examination(first white light mode and then fluorescence mode),biopsy of the lesions,brush-level alveolar lavage,according to the pathological results and the performance of the two models of lesions,compare the diagnostic value of AFB and WLB in bronchogenic lung cancer,and compare The diagnostic value of BALF and BWC guided by AFB in different pathological groups of lung cancer.ResultsAmong the 1026 patients,712 were pathologically positive and 314 were pathologically negative.The sensitivity of AFB and WLB to lung cancer diagnosis were 85.81%(611/712)and 74.02%(527/712),respectively(P<0.01).78.66%(247/314),71.66%(225/314)(P<0.05);positive predictive values were 90.12 %(611/678)and 85.55%(527/616),respectively(P<0.05);negative predictive values were 70.98%(247/348),54.88%(225/410)(P<0.05);the accuracy rates were 83.63%(858/1026)73.29%(752/1026)(P<0.01),respectively.The diagnostic value of the two methods for early lung cancer was compared.In the dysplasia group,the sensitivity of lung cancer detected by AFB was higher than that by WLB(43.75%)(P < 0.05).In the orthotopic cancer group,the sensitivity of lung cancer detected by AFB(76.92%)was higher than that by WLB(43.59%)(P < 0.01).The AFB and WLB grade II and III lesions were compared.In the grade II lesion group,the sensitivity of AFB and WLB to lung cancer diagnosis were 84.85%(280/330)and 76.14%(217/285),respectively(P<0.01).In the grade III disease group,the sensitivity of AFB and WLB for lung cancer diagnosis was 95.11%(331/348),93.66%(310/331)(P>0.05).The diagnostic value of AFB and WLB for different forms of lung cancer under white light microscope was compared.The sensitivity of WLB and AFB in lung cancer was 89.68% and 93.23%,respectively(P>0.05).In infiltration group,WLB and AFB were detected.The sensitivity of lung cancer was 72.26% and 84.52%,respectively(P<0.05).In the stenosis group,the sensitivity of detecting lung cancer by WLB and AFB was 57.52% and 75.22%,respectively(P<0.01).In the inflammation group,WLB and AFB were detected.The sensitivity of lung cancer was 46.27% and 59.70%,respectively(P<0.05).The positive detection rate of lung cancer in different lesions was compared with BWC,BALF and the combination of the two.The positive rate of lung cancer in the hyperplasia group,the infiltration group and the stenosis group were all in the positive rate of brushing(P<0.05).The rate was higher than the priming rate(P<0.05).In the inflammation group,the positive rate of brushing was higher than that of gestation(P<0.01),but the combined test did not improve the rate of positive(P>0.05).ConclusionThe sensitivity of AFB to early lung cancer(dysplasia and carcinoma in situ)was higher than that of WLB.There was no significant difference in the sensitivity of AFB to WLB in the diagnosis of lung cancer in white blood microscopy or in the AFB and WLB microscopic III group;in the invasive,inflammatory,stenotic or grade II disease group,AFB sensitivity is superior to WLB;AFB is more sensitive to suspected bronchogenic carcinoma than WLB,especially for patients with grade II AFB and WLB;AFB is more specific than WLB in patients with suspected lung cancer.AFB guidance can help to accurately locate the lesion.The positive rate of lung cancer diagnosed by BWC or BALF alone is low.The combined detection of BWC and BALF under AFB guidance can increase the detection rate of lung cancer.