Loizzi M, De Palma A, Lacitignola A, Genualdo M, Loizzi D, Capotorto G, Spada E, Sollitto F
U.O.C. di Chirurgia Toracica, Università degli Studi di Bari, Bari.
Minerva Chir. 2005 Dec;60(6):497-503.
Autofluorescence bronchoscopy (AFB) has been proposed to widen traditional white light bronchoscopy (WLB) possibilities of early diagnosis of neoplastic and preneoplastic lesions of the tracheo-bronchial mucosa in high risk groups. The authors report their study on AFB with the aim of establishing its role in the early diagnosis of bronchogenic carcinoma and its positive predictive value (PPV) compared and associated to WLB.
From May 2002 to May 2004 we performed WLB and AFB in 213 patients (177 males, 36 females), mean age 63.7 years (range 18-84 years), who were divided into 2 main groups (group A: patients at risk for bronchogenic carcinoma, n=82; group B: patients to be operated on for bronchogenic carcinoma, n=131). In total, 237 WLB-AFB were performed (101 in group A, 136 in group B) and 77 biopsies for pathological examination.
The 2 tools (WLB and AFB) were concordant in 156 (66%) and discordant in 81 (34%) cases. Considering the biopsies performed, we obtained a PPV of 26% for lesions visible with WLB, of 40% for those visible with AFB, of 38% for those visible with the association of both. In group A, in 56 patients of the follow-up subgroup, we found 2 dysplastic areas and 1 carcinoma in situ. In group B there was a discordant extension of the pathologic area visible with WLB and with AFB in 30 cases which was positive in 18 of them at histological examination.
In our experience, AFB has revealed to be a valid tool for both early diagnosis of neoplastic recurrences or a second primary lung neoplasia in patients in follow-up after resection and preoperative evaluation of resection margins in patients candidate to surgery. More studies are needed to widen its indications in the early diagnosis in high risk groups, to improve its potentialities and optimize its learning curve in order to establish the procedural guide lines.
有人提出自荧光支气管镜检查（AFB）可拓宽传统白光支气管镜检查（WLB）在高危人群中对气管支气管黏膜肿瘤性和肿瘤前病变的早期诊断可能性。作者报告了他们关于AFB的研究，目的是确定其在支气管源性癌早期诊断中的作用以及与WLB相比的阳性预测值（PPV）。
2002年5月至2004年5月，我们对213例患者（177例男性，36例女性）进行了WLB和AFB检查，平均年龄63.7岁（范围18 - 84岁），这些患者分为2个主要组（A组：支气管源性癌高危患者，n = 82；B组：拟行支气管源性癌手术的患者，n = 131）。总共进行了237次WLB - AFB检查（A组101次，B组136次），并进行了77次活检用于病理检查。
两种检查工具（WLB和AFB）在156例（66%）病例中结果一致，在81例（34%）病例中结果不一致。考虑所进行的活检，WLB可见病变的PPV为26%，AFB可见病变的PPV为40%，两者联合可见病变的PPV为38%。在A组的56例随访亚组患者中，我们发现2个发育异常区域和1例原位癌。在B组中，WLB和AFB可见的病理区域在30例中有不一致的范围，其中18例在组织学检查中呈阳性。
根据我们的经验，AFB已被证明是一种有效的工具，可用于对切除术后患者的肿瘤复发或第二原发性肺肿瘤进行早期诊断，以及对拟手术患者的手术切缘进行术前评估。需要更多研究来扩大其在高危人群早期诊断中的适应证，提高其潜力并优化其学习曲线，以建立操作指南。
