Moro-Sibilot Denis, Jeanmart Michel, Lantuejoul Sylvie, Arbib François, Laverrière Marie Hélène, Brambilla Elizabeth, Brambilla Christian
Lung Cancer Research Group, Institut National de la Santé et de la Recherche Médicale, Institut A. Bonniot, La Tronche, France.
Chest. 2002 Dec;122(6):1902-8. doi: 10.1378/chest.122.6.1902.
Autofluorescence bronchoscopy (AFB), when used as an adjunct to standard white light bronchoscopy (WLB), enhances the bronchoscopist's ability to localize small neoplastic lesions, especially intraepithelial lesions. The current study was undertaken in order to define the population in which the rate of detection is higher using AFB.
Two hundred forty-four consecutive patients, who were symptomatic smokers or patients who previously had been treated for lung cancer or head and neck cancers, underwent WLB and AFB. All patients with endoscopic abnormalities underwent biopsies. Data concerning smoking history were prospectively registered.
We report the prevalence of high-grade or invasive lesions at the time of examination. On a lesion-by-lesion analysis, 92 low-grade lesions, 42 high-grade lesions (ie, moderate dysplasia, severe dysplasia, and carcinoma in situ), and 39 invasive carcinomas were diagnosed. There was no effect of age, gender, and age at smoking initiation on the prevalence of preinvasive or invasive lesions. The 10 patients who previously had undergone surgery for lung cancer and exhibited high-grade preinvasive lesions had a history of carcinoma of the epidermoid histologic type (p = 0.01). These 10 patients displayed multiple lesions in the bronchial tree (mean No. of lesions, 1.8 per patient). In current smokers, the prevalence of high-grade or invasive lesions were both related to the number of pack-years smoking had occurred (p = 0.01) and to the duration of smoking (p = 0.01). In contrast, the prevalence of preinvasive lesions in former smokers was related to a history of epidermoid carcinoma.
AFB should be recommended in patients with a history of epidermoid carcinomas of the lung. Current smokers with a prolonged smoking history appear to comprise a population in which the rate of detection of preneoplastic lesions is high with AFB.
自体荧光支气管镜检查（AFB）作为标准白光支气管镜检查（WLB）的辅助手段，可提高支气管镜医师定位小肿瘤性病变尤其是上皮内病变的能力。本研究旨在确定使用AFB检测率较高的人群。
244例连续患者，包括有症状的吸烟者或既往曾接受肺癌或头颈癌治疗的患者，接受了WLB和AFB检查。所有内镜检查异常的患者均接受活检。前瞻性记录有关吸烟史的数据。
我们报告了检查时高级别或浸润性病变的患病率。逐病变分析显示，诊断出92例低级别病变、42例高级别病变（即中度发育异常、重度发育异常和原位癌）和39例浸润性癌。年龄、性别和开始吸烟年龄对癌前或浸润性病变的患病率没有影响。之前接受过肺癌手术且显示高级别癌前病变的10例患者有表皮样组织学类型的癌病史（p = 0.01）。这10例患者在支气管树中显示多个病变（平均病变数为每位患者1.8个）。在当前吸烟者中，高级别或浸润性病变的患病率均与吸烟包年数（p = 0.01）和吸烟持续时间（p = 0.01）有关。相比之下，既往吸烟者中癌前病变的患病率与表皮样癌病史有关。
对于有肺表皮样癌病史的患者，应推荐使用AFB。吸烟史较长的当前吸烟者似乎是AFB检测癌前病变率较高的人群。
