Author/Editor		Debeljak, Andrej; Triller, Nadja; Kecelj, Peter; Kern, Izidor
Title		Avtofluorescenčna bronhoskopija v diagnostiki preneoplastičnih sprememb in bronhialnega karcinoma
Translated title		Autofluorescence bronchoscopy in the diagnosis of preneoplastic changes and bronchial carcinoma
Type		članek
Source		Zdrav Vestn
Vol. and No.		Letnik 71, št. 7-8
Publication year		2002
Volume		str. 449-52
Language		slo
Abstract		Background. Fluorescence bronchoscopy is more sensitive than white light bronchoscopy in the diagnosis of preneoplastic changes of bronchial mucosa, carcinoma in situ and invasive bronchial cancer. Methods. Thirty-one patients, 22 male, 9 female age 59+-11 years were examined with autofluorescence system Storz 11004BI and D-light/AF with camera SL PDD and Olympus 1T30 or 1T40. Local anasthesia was applied. Bronchial biopsy was performed 3-5 times on macroscopically suspicious and apparently normal sites of bronchial mucosa. Each biopsy site was classified by white light (WLB), autofluorescence bronchoscopy (AFB) and histologically as normal epithelium, moderate dysplasia, severe dysplasia, and carcinoma in situ or invasive carcinoma. The results of WLB and AFB were compared with histological diagnosis. Results. We confirmed invasive carcinoma in 16, carcinoma in situ in 1 patient, pleural mesothelioma in 1 and benign diseases in 13 patients. Findings were classified as squamous cell (n=9), small cell (n=4), edenocarcinoma (n=3) and unclassifable (n=1) carcinoma. Biopsy was performed on 52 sites. Invasive carcinoma was histologically confirmed on 19 biopsy sites. WLB showed invasive carcinoma in 17 cases (89%) and AFB in 18 cases (95%). In the patient with carcinoma in situ WLB found mild dysplastic changes while AFB was positive. WLB sensitivity was 0.85 and AFB 0.95, while specificity of WLB was 0.91 and of AFB was 0.44. Relative sensitivity of WLB+AFB was 1.08 comparing with WLB alone. We observed false positive results because of former biopsies, bleeding, inflammation or scarring in patients with mild dysplasia and normal mucosa with WLB in 1 (3%) and with AFB in 5 (16%) cases. Conclusions. Autofluorescence was more sensitive than white light bronchoscopy in the diagnosis of invasive bronchial carcinoma, carcinoma in situ and dysplasia. False positive results must be considered.
Summary		Izhodišča. Fluorescenčna bronhoskopija je natančnejša kot običajna v prepoznavanju preneoplastičnih sprememb bronhialne sluznice, karcinoma in situ ter invazivnega pljučnega raka. Metode. V lokalni anesteziji smo z bronhoskopi Storz 11004BI z avtofluorescenčnim sistemom D-light/AF s kamero SL PDD ter Olympus 1T30 ali 1T40 pregledali 31 bolnikov, 22 moških in 9 žensk, v starosti 59 +- 11 let. Na sumljivih in tudi navidezno normalnih mestih smo naredili 3-5 biopsij bronhialne sluznice. Vsako mesto sluznice smo ocenili z običajno (B), avtofluorescenčno bronhoskopijo (AFB) in s histološkim pregledom epitela, kot normalno, blago ali težko displazijo, karcinom in situ ali kot invazivni karcinom. Bronhoskopske ugotovke smo primerjali s histološkimi. Rezultati. Bolezen, ki smo jih potrdili pri naših bolnikih, so bile:invazivni karcinom (n=16), karcinom in situ (n=1), plevralni mezoteliom (n=1) in benigne bolezni (n=13). Karcinomi so bili: ploščatocelični (n=9), drobnocelični (n=4), žlezni (n=3) ter neopredeljeni (n=1). Biopsije smo naredili na 52 mestih in na 19 ugotovili histološko invazivni bronhialni karcinom. Običajna B je pokazala invazivni karcinom na 17 (89%) in AFB na 18 (95%) mestih. Pri karcinomu in situ je B pokazala blage displastične spremembe in AFB jasno patološki izvid. Običajna B je imela senzitivnost 0,85, AFB 0,95 ter specifičnost B 0,91 in AFB 0,44. Relativna senzitivnost z dodatno uporabo AFB je bila 1,08. Lažno pozitivne izvide zaradi predhodnih biopsij, krvavitve, vnetja ali brazgotin smo našli z B na enem (3%) in z AFB na petih (16%) mestih. Zaključki. Avtofluorescenčna bronhoskopija je občutljivejša od običajne v diagnostiki invazivnega karcinoma, karcinoma in situ ter displastičnih sprememb. Upoštevati je treba lažno pozitivne izvide.
Descriptors		LUNG NEOPLASMS BRONCHOSCOPY CARCINOMA, BRONCHOGENIC FLUORESCENCE