D-light autofluorescence in the detection of premalignant airway changes: A multicenter trial

Carcinoma in situ and preinvasive lesions are difficult to detect by white light (WL) bronchoscopy. Autofluorescence (AF) bronchoscopy is an emerging technology that may increase the ability for early detection and curative treatment. We report on the effectiveness of an autofluorescence system to detect class III lesions in a large population. A multicenter prospective, nonrandomized, self-controlled study was performed in 5 university-affiliated tertiary care centers. Patients at high risk for pulmonary malignancies were eligible to undergo WL and AF bronchoscopy. Patients underwent biopsy of all suspicious class III lesions, as well as 2 biopsies from normal areas. Three hundred patients were included in the study; of those, 293 patients were included into the efficacy calculations with 832 biopsies. AF was superior to WL in sensitivity (61.2% vs. 10.6%) for detecting class III lesions (visual changes suggesting dysplasia, carcinoma in situ, or microinvasive cancer). The combined sensitivity was 65.9%. Specificity values were 75.3% and 72.7%, respectively, for AF and WL. On a per-patient basis harboring at least 1 premalignant area, the sensitivity for WL was 21.1% as compared with 84.2% for AF. Three deaths occurred within the study period but were unrelated to the device. In conclusion, the AF system is superior to conventional WL bronchoscopy in detecting premalignant lesions in a population at risk.