Lam S, MacAulay C, leRiche J C, Palcic B
Department of Respiratory Medicine, British Columbia Cancer Agency, Vancouver, Canada.
Cancer. 2000 Dec 1;89(11 Suppl):2468-73. doi: 10.1002/1097-0142(20001201)89:11+<2468::aid-cncr25>3.3.co;2-m.
Curative therapy is available for patients with Stage 0 lung carcinoma, with a >90% 5-year survival rate. Promising chemopreventive agents also are under investigation currently to reduce the risk of lung carcinoma in high risk populations. However, preinvasive bronchial lesions (moderate to severe dysplasia and carcinoma in situ) are very small and thin. They are difficult to localize by conventional white-light bronchoscopy. Fluorescence bronchoscopy is a new diagnostic tool for the detection of these preinvasive lesions.
The data on the use of fluorescence bronchoscopy to detect and localize preinvasive lesions in current heavy smokers and in former smokers at the British Columbia Cancer Agency as well as the worldwide experience cited in MEDLINE, Index Medicus, and Deutsches Institut fur Medizinische Dokumentation und Information (Cologne, Germany) comparing white-light and fluorescence bronchoscopy using the lung imaging fluorescence endoscope (LIFE)-Lung device (Xillix Technologies Corp., Richmond, British Columbia, Canada) were reviewed.
Among current heavy smokers and former smokers with sputum atypia, the prevalence of carcinoma in situ was 1.6%. Moderate or severe dysplasia was found in another 19%. The preinvasive lesions were found to be small: 55% measured < or = 1.5 mm in greatest dimension. Over 1000 cases have been reported in the literature between 1994 and 1999. Overall, 40% of the preinvasive lesions were detected by white-light bronchoscopy alone. The addition of fluorescence bronchoscopy increased the detection rate to an average of 80%.
Preinvasive lesions, especially dysplastic lesions, are small. They are difficult to detect and localize by white-light bronchoscopy. Fluorescence bronchoscopy improves the detection rate. It is an important part of the armamentarium in the overall management of early lung cancer.
0期肺癌患者可采用根治性治疗，其5年生存率超过90%。目前也正在研究有前景的化学预防药物，以降低高危人群患肺癌的风险。然而，侵袭前支气管病变（中度至重度发育异常和原位癌）非常小且薄。通过传统的白光支气管镜很难定位这些病变。荧光支气管镜是检测这些侵袭前病变的一种新的诊断工具。
回顾了不列颠哥伦比亚癌症机构使用荧光支气管镜检测和定位当前重度吸烟者和既往吸烟者中侵袭前病变的数据，以及MEDLINE、《医学索引》和德国医学文献与信息研究所（德国科隆）引用的全球经验，这些经验比较了使用肺部成像荧光内镜（LIFE）-Lung设备（加拿大不列颠哥伦比亚省里士满市Xillix Technologies Corp.）的白光支气管镜和荧光支气管镜。
在有痰异型性的当前重度吸烟者和既往吸烟者中，原位癌的患病率为1.6%。另外19%发现有中度或重度发育异常。发现侵袭前病变很小：55%的最大直径≤1.5毫米。1994年至1999年期间，文献报道了1000多例病例。总体而言，仅通过白光支气管镜检测到40%的侵袭前病变。增加荧光支气管镜后，检测率平均提高到80%。
侵袭前病变，尤其是发育异常病变很小。通过白光支气管镜很难检测和定位。荧光支气管镜提高了检测率。它是早期肺癌整体管理手段中的重要组成部分。
