nurdan kalkan, gülşah günlüoğlu, sedat altın, erdoğan Çetinkaya, nurdan Şimşek

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EFFECT OF AUTOFLORESCENT BRONCHOSCOPY TO DETECTING NEW CANCER OR PREMALIGN LESION IN PATIENTS OPERATED DUE TO LUNG

CANCER

Nurdan Kalkan, Gülşah Günlüoğlu, Sedat Altın, Erdoğan Çetinkaya, Nurdan Şimşek

Yedikule Chest Diseases and Thoracic Surgery Center

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Lung cancer

Early diagnosis Endobronchial therapy Better survival

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Early diagnosis

Molecular genetic abnormalities, Metaplasia, Displasia, CIS, İnvasive carcinoma

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Çok erken tanı

Sputum cytology

Invasive carcinoma Radiographs

Bronchoscopy Premalign lesion

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White Light Bronchoscopy(WLB)

Nodular, polypoid 2mm Mucosal >5mm CIS under basal membran in 75% of patients

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Autoflorescent Bronchoscopy(AFB)

Light on normal mucosa Reflection Absorbtion can seen Dispersion

Florescence can not seen

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Florescence

Structural elements of tissue (collogen, elastin)

Cellular metabolites (NADH, flavines) Aromatic aminoacides, porfirines,

lipopigments

Decreases at pathologic tissue

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Florescence

Potentialisation of the florescence

( with hematoporfirine derives)

Detecting autoflorescence

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Autoflorescence

The rate of detected premalign lesion is more than with white light

(Venmans, Lam, O’Neill..)

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Study

In operated patients due to lung cancer

(who encountered with carcinogens)

To detecting existence of premalign lesion

(no invasive carcinoma)

Effect of AFB when compared with WLB

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Patients

40 patients operated on due to lung cancer 39 male, 1 female, with mean age of 58,1 Cigarette 57 p.p. year 8 ex-smoker

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Procedure

At same session Experienced bronchoscopyst Biopsies from bronchial stump in all

patients(40) Biopsies from other pathological seen areas Histopathological examination Comparing sensitivities and spesivicities of

WLB and AFB

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Patients

31% epidermoid carcinoma 72,5% lobectomy 42% stage 2 17,5% stage 3A 37,5% adjuvant therapy Mean time between surgery and

bronchoscopy is 21,4 month

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Bronchial stump areas

WLB: 2 pathologic areas 2 cancer

AFB: 6 pathologic areas 2 cancer, 4 normal

Pathologic exam: 5 pathologic areas 2 cancer, 3 metaplasia

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Bronchial stump areas

WLB:

Sensitivity: 40%

FP:0

AFB:

Sensitivity:40%

FP:66%

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Areas other than bronchial stump

WLB: 2 pathologic areas:

– 1 cancer, – 1 metaplasia

1 low grade, 1 high grade

AFB: 8 pathologic areas:

– 1 cancer – 1 high displasia, – 3 metaplasia,– 3 normal

3 low grade, 2 high grade

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Areas other than bronchial stump

WLB:

Sensitivity:40%

FP:0

AFB:

Sensitivity:100%

FP:37%

Relative sensitivity of AFB is more than WLB 2,5 times

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All biopsies

WLB:

Sensitivity:40%

FP:0

AFB:

Sensitivity:70%

FP:50%

Relative sensitivity of AFB is more than WLB 1,75 times

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Low grade lesions

(metaplasia, low grade displasia)

Sensitivity of WLB: 17%(1/6) Sensitivity of AFB : 50%(3/6)

Relative sensitivity of AFB is more than WLB 2,94 times

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Yüksek grade

(moderate and high grade displasia, CIS,

carcinoma)

Sensitivity of WLB: %75 (3/4) Sensitivity of AFB : %100 (4/4)

Relative sensitivity of AFB is more than WLB 1,33 times

Number of patients, number of invasive carcinomas

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Other results

There is no effect of tumor type on developing new lesion

There is no effect of surgical procedure type on developing new lesion

There is no effect of continue to smoking on developing new lesion

AFB could detect all lesions detected by WLB

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False positivity of AFB

İnflammation, Effect of surgery on bronchial stump areas, İndividual degree of florophores on normal

mucosa, Bronchoscopist and patholog factors, Molecular carcinonogenesis Reported 1/3 Have not bad effect except need of additional biopsy

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False negativity of AFB

Changes secondary to surgery Folding of mucosa Longutidunal swelling of membranous side

may hide small lesions Bronchoscopist and patholog factors

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Conclusion

SENSITIVITY OF AFB IS MORE THAN WLB TO DIAGNOSING NEW CANCER OR PREMALIGN LESIONS IN OPERATED NSCLC PATIENTS