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Nurdan Kalkan, Gülşah Günlüoğlu, Sedat Altın, Erdoğan Çetinkaya, Nurdan Şimşek

EFFECT OF AUTOFLORESCENT BRONCHOSCOPY TO DETECTING NEW CANCER OR PREMALIGN LESION IN PATIENTS OPERATED DUE TO LUNG CANCER. Nurdan Kalkan, Gülşah Günlüoğlu, Sedat Altın, Erdoğan Çetinkaya, Nurdan Şimşek Yedikule Chest Diseases and Thoracic Surgery Center. Lung cancer. Early diagnosis

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Nurdan Kalkan, Gülşah Günlüoğlu, Sedat Altın, Erdoğan Çetinkaya, Nurdan Şimşek

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  1. EFFECT OF AUTOFLORESCENT BRONCHOSCOPY TO DETECTING NEW CANCER OR PREMALIGN LESION IN PATIENTS OPERATED DUE TO LUNG CANCER Nurdan Kalkan, Gülşah Günlüoğlu, Sedat Altın, Erdoğan Çetinkaya, Nurdan Şimşek Yedikule Chest Diseases and Thoracic Surgery Center

  2. Lung cancer • Early diagnosis • Endobronchial therapy • Better survival

  3. Early diagnosis • Molecular genetic abnormalities, • Metaplasia, • Displasia, • CIS, • İnvasive carcinoma

  4. Çok erken tanı • Sputum cytology Invasive carcinoma • Radiographs • Bronchoscopy Premalign lesion

  5. White Light Bronchoscopy(WLB) • Nodular, polypoid 2mm • Mucosal >5mm • CIS under basal membran in 75% of patients

  6. Autoflorescent Bronchoscopy(AFB) Light on normal mucosa • Reflection • Absorbtion can seen • Dispersion • Florescence can not seen

  7. Florescence • Structural elements of tissue (collogen, elastin) • Cellular metabolites (NADH, flavines) • Aromatic aminoacides, porfirines, lipopigments • Decreases at pathologic tissue

  8. Florescence • Potentialisation of the florescence ( with hematoporfirine derives) • Detecting autoflorescence

  9. Autoflorescence • The rate of detected premalign lesion is more than with white light • (Venmans, Lam, O’Neill..)

  10. Study • In operated patients due to lung cancer (who encountered with carcinogens) • To detecting existence of premalign lesion (no invasive carcinoma) • Effect of AFB when compared with WLB

  11. Patients • 40 patients operated on due to lung cancer • 39 male, 1 female, with mean age of 58,1 • Cigarette 57 p.p. year • 8 ex-smoker

  12. Procedure • At same session • Experienced bronchoscopyst • Biopsies from bronchial stump in all patients(40) • Biopsies from other pathological seen areas • Histopathological examination • Comparing sensitivities and spesivicities of WLB and AFB

  13. Patients • 31% epidermoid carcinoma • 72,5% lobectomy • 42% stage 2 • 17,5% stage 3A • 37,5% adjuvant therapy • Mean time between surgery and bronchoscopy is 21,4 month

  14. WLB: 2 pathologic areas 2 cancer AFB: 6 pathologic areas 2 cancer, 4 normal Bronchial stump areas Pathologic exam: 5 pathologic areas 2 cancer, 3 metaplasia

  15. WLB: Sensitivity: 40% FP:0 AFB: Sensitivity:40% FP:66% Bronchial stump areas

  16. WLB: 2 pathologic areas: 1 cancer, 1 metaplasia 1 low grade, 1 high grade AFB: 8 pathologic areas: 1 cancer 1 high displasia, 3 metaplasia, 3 normal 3 low grade, 2 high grade Areas other than bronchial stump

  17. WLB: Sensitivity:40% FP:0 AFB: Sensitivity:100% FP:37% Areas other than bronchial stump Relative sensitivity of AFB is more than WLB 2,5 times

  18. WLB: Sensitivity:40% FP:0 AFB: Sensitivity:70% FP:50% All biopsies Relative sensitivity of AFB is more than WLB 1,75 times

  19. Low grade lesions (metaplasia, low grade displasia) • Sensitivity of WLB: 17%(1/6) • Sensitivity of AFB : 50%(3/6) • Relative sensitivity of AFB is more than WLB 2,94 times

  20. Yüksek grade (moderate and high grade displasia, CIS, carcinoma) • Sensitivity of WLB: %75 (3/4) • Sensitivity of AFB : %100 (4/4) Relative sensitivity of AFB is more than WLB 1,33 times • Number of patients, number of invasive carcinomas

  21. Other results • There is no effect of tumor type on developing new lesion • There is no effect of surgical procedure type on developing new lesion • There is no effect of continue to smoking on developing new lesion • AFB could detect all lesions detected by WLB

  22. False positivity of AFB • İnflammation, • Effect of surgery on bronchial stump areas, • İndividual degree of florophores on normal mucosa, • Bronchoscopist and patholog factors, • Molecular carcinonogenesis • Reported 1/3 • Have not bad effect except need of additional biopsy

  23. False negativity of AFB • Changes secondary to surgery • Folding of mucosa • Longutidunal swelling of membranous side may hide small lesions • Bronchoscopist and patholog factors

  24. Conclusion • SENSITIVITY OF AFB IS MORE THAN WLB TO DIAGNOSING NEW CANCER OR PREMALIGN LESIONS IN OPERATED NSCLC PATIENTS

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