Deciding on a treatment approach for early stage lung cancer (0-1) is sometimes difficult because of uncertainties regarding the depth of tumour invasion and its margins. Even with advanced technology, such as endobronchial ultrasound and autofluorescence bronchoscopy, it is often difficult to be precise. In this currently discussed case, treatment of a 61-year-old female patient with early stage IA lung cancer could not proceed for such reasons. Fortunately, timely surgical intervention allowed preservation of lung function and the patient is now under close surveillance.
As part of a retrospective study on bronchoscopies performed at the Clinic of Pneumonology and Phthisiatry of the University Hospital – Pleven by autofluorescence bronchoscopy we found 3 cases diagnosed with carcinoma in situ. They were treated in different ways – endobronchial electrocoagulation, extraction by forceps biopsy and open surgery, but the result was the same – clinical healing. The paper presents the three clinical cases and the analysis of the treatment.
Background: Autofluorescence bronchoscopy (AFB) allows a more sensitive approach to the diagnosis of premalignant and malignant endobronchial lesions than white light bronchoscopy (WLB) can do.
Aim: To assess the autofluorescence bronchoscopy and white light bronchoscopy in diagnosing malignant endobronchial lesions.
Materials and methods: The design of the study is a retrospective case-control study. Thirty-two parameters were entered into an Excel file and analysed with SPSS v. 21 for Mac book Pro. Endoscopy findings were graded in 4 options and morphological results - in 9 options according to WHO classification. The results are presented using McNemar’s test and sensitivity, specificity and positive and negative predictive values as well.
Results: Three hundred and three patients were included in the study. Lung cancer was found in 38.3% of the patients using histology and in 35.6% - using cytology. McNemar’s test for AFB finding for suspected and malignant lesions OR was 8.333 (95% CI 3.571-23.784) while for WLB OR was 0.128 (95% CI 0.045-0.299). For cytological results OR was 3.800 (95% CI 2.123-7.227) and 3.471 (95% CI 1.996-6.351), respectively. P value was <0.0001 for all tests. Sensitivity for AFB and WLB was 94.83% but specificity was 52.83% and 55.66% if histology was used. For cytology these numbers were respectively 86.11% and 84.26% for sensitivity, and 63.69% and 62.42% for specificity.
Conclusion: AFB has an advantage over WLB in diagnosing endobronchial malignant lesions. Biopsying suspicious, not only visible malignant lesions, increased diagnostic sensitivity.