|Fluorescence versus white-light bronchoscopy for detection of preneoplastic lesions: a randomized study.|
|PMID: 11562389 Owner: NLM Status: MEDLINE|
|BACKGROUND: There are no currently approved methods for the screening and early detection of lung cancer. We compared 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 bronchoscopists were randomly assigned. METHODS: The study included high-risk subjects enrolled because of a cigarette smoking history of at least 30 pack-years, an air-flow obstruction, 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 significantly more sensitive than WLB for detecting moderate dysplasia or worse (68.8% versus 21.9%, respectively) (difference = 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 were similar regardless of the order of the procedures or the order of the bronchoscopists. Also, LIFE was better at identifying angiogenic squamous dysplasia lesions than WLB (detection ratio [DR], which indicates the relative likelihood of getting a positive result in a sample with dysplasia compared with one without, for LIFE = 1.39 [95% CI = 1.17 to 1.65] versus DR for WLB = 0.67 [95% CI = 0.38 to 1.21]). CONCLUSION: LIFE was more sensitive than WLB in detecting preneoplastic bronchial changes in high-risk subjects. The prognostic implication of this finding is not yet clear.|
|F R Hirsch; S A Prindiville; Y E Miller; W A Franklin; E C Dempsey; J R Murphy; P A Bunn; T C Kennedy|
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|Type: Clinical Trial; Comparative Study; Journal Article; Randomized Controlled Trial; Research Support, Non-U.S. Gov't; Research Support, U.S. Gov't, P.H.S.|
|Title: Journal of the National Cancer Institute Volume: 93 ISSN: 0027-8874 ISO Abbreviation: J. Natl. Cancer Inst. Publication Date: 2001 Sep|
|Created Date: 2001-09-19 Completed Date: 2001-12-04 Revised Date: 2007-11-14|
Medline Journal Info:
|Nlm Unique ID: 7503089 Medline TA: J Natl Cancer Inst Country: United States|
|Languages: eng Pagination: 1385-91 Citation Subset: IM|
|Department of Pathology, University of Colorado Health Sciences Center and Cancer Center, Denver, USA.|
|APA/MLA Format Download EndNote Download BibTex|
Airway Obstruction / epidemiology
Bronchoscopy / methods*
Carcinoma / diagnosis, epidemiology, prevention & control
Carcinoma in Situ / diagnosis, epidemiology
Epithelial Cells / pathology
Lung Diseases / diagnosis*, epidemiology, pathology
Lung Neoplasms / diagnosis, epidemiology, prevention & control*
Mass Screening / methods
Neovascularization, Pathologic / diagnosis, pathology
Precancerous Conditions / diagnosis*, epidemiology, pathology
Sensitivity and Specificity
Smoking / epidemiology
Sputum / cytology
|KO7CA75159/CA/NCI NIH HHS; P50CA58187/CA/NCI NIH HHS|
From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine
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