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Minerva Pneumologica 2005 March;44(1):1-6

Copyright © 2005 EDIZIONI MINERVA MEDICA

language: English

Autofluorescence bronchoscopy

Islam S., Beamis J. F. Jr.

Autofluorescence bronchoscopy (AFB) exploits the inherent fluorescence property of cancerous tissue. It improves detection of premalignant lesions not seen with white light bronchoscopy (WLB) by 1.3 to 2.7 fold. It is safe, relatively non invasive and has comparable morbidity with WLB. Squamous cell carcinoma, dysplasia and carcinoma in situ are easily recognized with AFB because of their superficial development. Deeper forms of cancer such as adenocarcinoma or lesions located peripherally are difficult to identify with AFB. Newer autofluorescence systems with non laser light source are less expensive than earlier models and offer superior quality images. Current use of AFB includes screening high-risk populations for precancerous lesions or to determine the resection line of invasive cancer preoperatively. It can also be used to monitor effectiveness of various endobronchial therapies or to diagnose synchronous and metachronous lesions. AFB is highly sensitive in identifying angiogenic squamous dysplasia (ASD) thought to be a key step in the transition of intraepithelial neoplasia to submucosal invasion. Use of a universal histological classification system will improve diagnosis and staging. A relatively higher number of biopsies taken with AFB contribute to the low specificity. The ability of AFB to identify subtle genetic or cellular abnormalities undetectable on morphologic examination is under investigation. AFB combined with high resolution computed tomogram (HRCT) or endobronchial ultrasound (EBUS) might be a useful tool in the future for accurate staging of cancers that are amenable to endobronchial therapies.