- 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].
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