- Anindo K Banerjee, PhD, FRCP
Anindo K Banerjee, PhD, FRCP
- Consultant Respiratory Physician
- Southampton General Hospital, Southampton, UK
Squamous cell carcinoma of the bronchus develops from carcinogen-exposed bronchial epithelium. It probably progresses through a series of preinvasive lesions (metaplasia, dysplasia, carcinoma in situ), followed by microinvasive carcinoma and then fully invasive carcinoma .
Fluorescence bronchoscopy was developed to identify preinvasive lesions. The hope is that identification and treatment of such lesions may improve the outcome from squamous cell carcinoma of the bronchus [2-4].
Technical aspects of fluorescence bronchoscopy and its clinical role are reviewed here. Lung cancer screening, evaluation, and treatment are discussed separately. (See "Screening for lung cancer" and "Overview of the initial evaluation, treatment and prognosis of lung cancer".)
It has been known since the early part of the last century that tissues fluoresce when exposed to light of a suitable wavelength and that the fluorescence is altered by infiltrating tumors [5,6]. It was hypothesized that such differences in fluorescence might help detect tumors in the airways, but initial attempts were unsuccessful because either the intensity of fluorescence was too low to be detected with the naked eye or the fluorescence was obscured by light reflected from the bronchoscope's excitation beam. Photosensitizing fluorescent compounds (eg, hematoporphyrin derivatives) were used to increase the intensity of the fluorescence, but this approach was limited by skin photosensitivity [7,8]. As a result of these limitations, interest in fluorescence bronchoscopy diminished.
Technological advances in image acquisition and processing have improved the detection of subtle differences in fluorescence without the use of a fluorophore. This has renewed interest in fluorescence bronchoscopy. Dysplasia, carcinoma in situ, and microinvasive carcinoma exhibit much weaker green fluorescence and slightly weaker red fluorescence than normal tissues, when illuminated by light with a wavelength of 380 to 440 nm (blue spectrum) . The reasons for the differences in fluorescence are not well understood, but may be due to increased epithelial thickness, increased blood flow, and/or a reduced concentration of fluorophores in abnormal tissue [10,11].To continue reading this article, you must log in with your personal, hospital, or group practice subscription. For more information on subscription options, click below on the option that best describes you:
- Hirsch FR, Franklin WA, Gazdar AF, Bunn PA Jr. Early detection of lung cancer: clinical perspectives of recent advances in biology and radiology. Clin Cancer Res 2001; 7:5.
- Banerjee AK, Rabbitts PH, George J. Lung cancer . 3: Fluorescence bronchoscopy: clinical dilemmas and research opportunities. Thorax 2003; 58:266.
- Bolliger CT, Mathur PN, Beamis JF, et al. ERS/ATS statement on interventional pulmonology. European Respiratory Society/American Thoracic Society. Eur Respir J 2002; 19:356.
- Ernst A, Silvestri GA, Johnstone D, American College of Chest Physicians. Interventional pulmonary procedures: Guidelines from the American College of Chest Physicians. Chest 2003; 123:1693.
- Sutro, CJ, Burman, MS. Examination of pathologic tissue by filtered ultraviolet radiation. Arch Pathol 1933; 16:346.
- Herly, L. Studies in selective differentiation of tissues by means of filtered ultraviolet light. Cancer Res 1943; 1:227.
- LIPSON RL, BALDES EJ. The photodynamic properties of a particular hematoporphyrin derivative. Arch Dermatol 1960; 82:508.
- Kato H, Cortese DA. Early detection of lung cancer by means of hematoporphyrin derivative fluorescence and laser photoradiation. Clin Chest Med 1985; 6:237.
- Hung J, Lam S, LeRiche JC, Palcic B. Autofluorescence of normal and malignant bronchial tissue. Lasers Surg Med 1991; 11:99.
- Qu J, MacAulay C, Lam S, et al. Laser induced fluorescence spectroscopy at endoscopy: Tissue optics; Monte Carlo modeling and in vivo measurements. Optical Eng 1995; 34:3334.
- Qu J, MacAulay C, Lam S, Palcic B. Mechanisms of ratio fluorescence imaging of diseased tissue. Society of Photo-optical Instrumentation Engineers 1995; 2387:71.
- McWilliams A, Lam B, Sutedja T. Early proximal lung cancer diagnosis and treatment. Eur Respir J 2009; 33:656.
- Lam S, MacAulay C, Hung J, et al. Detection of dysplasia and carcinoma in situ with a lung imaging fluorescence endoscope device. J Thorac Cardiovasc Surg 1993; 105:1035.
- Lam S, Macaulay C, Leriche JC, et al. Early localization of bronchogenic carcinoma. Diagn Ther Endosc 1994; 1:75.
- Edell E, Lam S, Pass H, et al. Detection and localization of intraepithelial neoplasia and invasive carcinoma using fluorescence-reflectance bronchoscopy: an international, multicenter clinical trial. J Thorac Oncol 2009; 4:49.
- Leonhard M. New incoherent autofluorescence/fluorescence system for early detection of lung cancer. Diagn Ther Endosc 1999; 5:71.
- Ikeda N, Honda H, Hayashi A, et al. Early detection of bronchial lesions using newly developed videoendoscopy-based autofluorescence bronchoscopy. Lung Cancer 2006; 52:21.
- Goujon D, Zellweger M, Radu A, et al. In vivo autofluorescence imaging of early cancers in the human tracheobronchial tree with a spectrally optimized system. J Biomed Opt 2003; 8:17.
- Chiyo M, Shibuya K, Hoshino H, et al. Effective detection of bronchial preinvasive lesions by a new autofluorescence imaging bronchovideoscope system. Lung Cancer 2005; 48:307.
- Lam S, Kennedy T, Unger M, et al. Localization of bronchial intraepithelial neoplastic lesions by fluorescence bronchoscopy. Chest 1998; 113:696.
- Herth FJ, Ernst A, Becker HD. Autofluorescence bronchoscopy--a comparison of two systems (LIFE and D-Light). Respiration 2003; 70:395.
- Häußinger K, Stanzel F, Huber RM, et al. Autofluorescence Detection of Bronchial Tumors With the D-Light/AF. Diagn Ther Endosc 1999; 5:105.
- Venmans BJ, van der Linden H, van Boxem TJ, et al. Early detection of preinvasive lesions in high-risk patients: A comparison of conventional flexible and fluorescence bronchoscopy. J Bronchol 1998; 5:280.
- Hirsch FR, Prindiville SA, Miller YE, et al. Fluorescence versus white-light bronchoscopy for detection of preneoplastic lesions: a randomized study. J Natl Cancer Inst 2001; 93:1385.
- Ikeda N, Hiyoshi T, Kakihana M, et al. Histopathological evaluation of fluorescence bronchoscopy using resected lungs in cases of lung cancer. Lung Cancer 2003; 41:303.
- Kennedy TC, McWilliams A, Edell E, et al. Bronchial intraepithelial neoplasia/early central airways lung cancer: ACCP evidence-based clinical practice guidelines (2nd edition). Chest 2007; 132:221S.
- Häussinger K, Becker H, Stanzel F, et al. Autofluorescence bronchoscopy with white light bronchoscopy compared with white light bronchoscopy alone for the detection of precancerous lesions: a European randomised controlled multicentre trial. Thorax 2005; 60:496.
- Kurie JM, Lee JS, Morice RC, et al. Autofluorescence bronchoscopy in the detection of squamous metaplasia and dysplasia in current and former smokers. J Natl Cancer Inst 1998; 90:991.
- O'Neil KM, Johnson BE. Lights flicker on fluorescence bronchoscopy in patients at risk for lung cancer. J Natl Cancer Inst 1998; 90:953.
- Helfritzsch H, Junker K, Bartel M, Scheele J. Differentiation of positive autofluorescence bronchoscopy findings by comparative genomic hybridization. Oncol Rep 2002; 9:697.
- National Lung Cancer Audit Report 2006. The Information Centre for Health and Social Care. Leeds, UK.
- Imperatori A, Harrison RN, Leitch DN, et al. Lung cancer in Teesside (UK) and Varese (Italy): a comparison of management and survival. Thorax 2006; 61:232.
- Groome PA, Bolejack V, Crowley JJ, et al. The IASLC Lung Cancer Staging Project: validation of the proposals for revision of the T, N, and M descriptors and consequent stage groupings in the forthcoming (seventh) edition of the TNM classification of malignant tumours. J Thorac Oncol 2007; 2:694.
- Pearson FG. Current status of surgical resection for lung cancer. Chest 1994; 106:337S.
- Spiro SG. Lung Tumours. In: Respiratory Medicine, Brewis RA, Gibson GJ, Geddes DM (Eds), Bailliere Tindall, 1990. p.832-79.
- AUERBACH O, FORMAN JB, GERE JB, et al. Changes in the bronchial epithelium in relation to smoking and cancer of the lung; a report of progress. N Engl J Med 1957; 256:97.
- Woolner LB, Fontana RS, Cortese DA, et al. Roentgenographically occult lung cancer: pathologic findings and frequency of multicentricity during a 10-year period. Mayo Clin Proc 1984; 59:453.
- Pasic A, Vonk-Noordegraaf A, Risse EK, et al. Multiple suspicious lesions detected by autofluorescence bronchoscopy predict malignant development in the bronchial mucosa in high risk patients. Lung Cancer 2003; 41:295.
- Bota S, Auliac JB, Paris C, et al. Follow-up of bronchial precancerous lesions and carcinoma in situ using fluorescence endoscopy. Am J Respir Crit Care Med 2001; 164:1688.
- Deygas N, Froudarakis M, Ozenne G, Vergnon JM. Cryotherapy in early superficial bronchogenic carcinoma. Chest 2001; 120:26.
- Venmans BJ, van Boxem TJ, Smit EF, et al. Outcome of bronchial carcinoma in situ. Chest 2000; 117:1572.
- Cortese DA, Edell ES, Kinsey JH. Photodynamic therapy for early stage squamous cell carcinoma of the lung. Mayo Clin Proc 1997; 72:595.
- van Boerdonk RA, Smesseim I, Heideman DA, et al. Close Surveillance with Long-Term Follow-up of Subjects with Preinvasive Endobronchial Lesions. Am J Respir Crit Care Med 2015; 192:1483.
- Breuer RH, Pasic A, Smit EF, et al. The natural course of preneoplastic lesions in bronchial epithelium. Clin Cancer Res 2005; 11:537.
- Banerjee AK, Rabbitts PH, George PJ. Are all high-grade preinvasive lesions premalignant, and should they all be treated? Am J Respir Crit Care Med 2002; 165:1452.
- Satoh Y, Ishikawa Y, Nakagawa K, et al. A follow-up study of progression from dysplasia to squamous cell carcinoma with immunohistochemical examination of p53 protein overexpression in the bronchi of ex-chromate workers. Br J Cancer 1997; 75:678.
- Thiberville L, Payne P, Vielkinds J, et al. Evidence of cumulative gene losses with progression of premalignant epithelial lesions to carcinoma of the bronchus. Cancer Res 1995; 55:5133.
- Banerjee AK. Preinvasive lesions of the bronchus. J Thorac Oncol 2009; 4:545.
- Moro-Sibilot D, Fievet F, Jeanmart M, et al. Clinical prognostic indicators of high-grade pre-invasive bronchial lesions. Eur Respir J 2004; 24:24.
- Jeremy George P, Banerjee AK, Read CA, et al. Surveillance for the detection of early lung cancer in patients with bronchial dysplasia. Thorax 2007; 62:43.
- McWilliams AM, Mayo JR, Ahn MI, et al. Lung cancer screening using multi-slice thin-section computed tomography and autofluorescence bronchoscopy. J Thorac Oncol 2006; 1:61.
- Loewen G, Natarajan N, Tan D, et al. Autofluorescence bronchoscopy for lung cancer surveillance based on risk assessment. Thorax 2007; 62:335.