Background: Computed tomography (CT) and bronchoscopy have been shown to improve the detection rates of peripheral and central lung cancers (LC), respectively. However, the performance of the combination of CT and bronchoscopy in detecting LC, in high-risk patients, is not clear. Patients & Methods: This prospective study included 205 high-risk patients with a history of at least 2 of the following risk factors: (1) heavy smoking; (2) aero-digestive cancer; (3) pulmonary asbestosis or; (4) chronic obstructive pulmonary disease. Patients were offered chest X-ray, sputum cytology, conventional white-light followed by autofluorescence beonchoscopy (WL/AFB) and low-dose spiral CT both at baseline and follow-up visits. Results: Seven patients (3.4%) were diagnosed with LC or carcinoma in-situ (CIS) at baseline: CT evaluation detected 5 LC/CIS, while WL/AFB evaluation also identified 5 LC/CIS, 2 of which were not detected on CT. Six (85%) of these baseline lesions were early stage (0/IA). The relative-sensitivity of CT with WL/ AFB was 40% better than CT alone. On four year follow-up, 20 patients (9.8%) were diagnosed with an LC/CIS. CT with WL/AFB detected 19 cases (95%), whereas CT alone detected 15 cases (75%). Conclusion: Bimodality surveillance with spiral CT and WL/AFB can improve the detection of early stage LCs among high-risk patients
A. Jemal, F. Bray, M. M. Center, J. Ferlay, E. Ward and D. Forman, “Global Cancer Statistics,” CA: A Cancer Journal for Clinicians, Vol. 61, No. 2, 2011, pp. 69-90. doi:10.3322/caac.20107
A. Jemal, R. Siegel, J. Xu and E. Ward, “Cancer Statistics, 2010,” CA: A Cancer Journal for Clinicians, Vol. 60, No. 5, 2010, pp. 277-300. doi:10.3322/caac.20073
M. D. Brundage, D. Davies and W. J. Mackillop, “Prognostic Factors in Non-Small Cell Lung Cancer: A Decade of Progress,” Chest, Vol. 122, No. 3, 2002, pp. 1037-1057. doi:10.1378/chest.122.3.1037
W. D. Travis, E. Brambilla and H. K. Muller-Hermelink Eds., “Pathology and Genetics: Tumours of the Lung, Pleura, Thymus and Heart,” IARC Press, Lyon, 2004.
J. K. Frost, W. C. Ball Jr., M. L. Levin, M. S.Tockman, R. R. Baker, D. Carter, J. C. Eggleston, Y. S. Erozan, P. K. Gupta, N. F. Khouri, et al., “Early Lung Cancer Detection: Results of the Initial (Prevalence) Radiologic and Cytologic Screening in the Johns Hopkins Study,” The American Review Respiratory Disease, Vol. 130, No. 4, 1984, pp. 549-554.
M. R. Melamed, B. J. Flehinger, M. B. Zaman, R. T. Heelan, W. A. Perchick and N. Martini, “Screening for Early Lung Cancer. Results of the Memorial Sloan-Kettering Study in New York,” Chest, Vol. 86, No. 1, 1984, pp. 44-53. doi:10.1378/chest.86.1.44
M. R. Melamed, “Lung Cancer Screening Results in the National Cancer Institute New York Study,” Cancer, Vol. 89, No. 11, 2000, pp. 2356-2362. doi:10.1002/1097-0142(20001201)89:11+ 3.0.CO;2-Z
P. M. Marcus, E. J. Bergstralh, R. M. Fagerstrom, D. E. Williams, R. Fontana, W. F. Taylor and P. C. Prorok, “Lung Cancer Mortality in the Mayo Lung Project: Impact of Extended Follow-Up,” Journal of the National Cancer Institute, Vol. 92, No. 16, 2000, pp. 1308-1316. doi:10.1093/jnci/92.16.1308
C. I. Henschke, D. I. McCauley, D. F. Yankelevitz, D. P. Naidich, G. McGuinness, O. S. Miettinen, D. M. Libby, M. W. Pasmantier, J. Koizumi, N. K. Altorki, et al., “Early Lung Cancer Action Project: Overall Design and Findings from Baseline Screening,” Lancet, Vol. 354, No. 9173, 1999, pp. 99-105. doi:10.1016/S0140-6736(99)06093-6
S. J. Swensen, J. R. Jett, T. E. Hartman, D. E. Midthun, S. J. Mandrekar, S. L. Hillman, A. M. Sykes, G. L. Aughenbaugh, A. O. Bungum and K. L. Allen, “CT Screening for Lung Cancer: Five-Year Prospective Experience,” Radiology, Vol. 235, No. 1, 2005, pp. 259-265. doi:10.1148/radiol.2351041662
S. Sone, S. Takashima, F. Li, Z. Yang, T. Honda, Y. Maruyama, M. Hasegawa, T. Yamanda, K. Kubo, K. Hanamura, et al., “Mass Screening for Lung Cancer with Mobile Spiral Computed Tomography Scanner,” Lancet, Vol. 351, No. 9111, 1998, pp. 1242-1245. doi:10.1016/S0140-6736(97)08229-9
C. I. Henschke, P. Boffetta, O. Gorlova, R. Yip, J. O. Delancey and M. Foy, “Assessment of Lung-Cancer Mortality Reduction from CT Screening,” Lung Cancer, Vol. 71, No. 3, 2011, pp. 328-332. doi:10.1016/j.lungcan.2010.10.025
D. R. Aberle, C. D. Berg, W. C. Black, T. R. Church, R. M. Fagerstrom, B. Galen, I. F. Gareen, C. Gatsonis, J. Goldin, J. K. Gohagan, et al., “The National Lung Screening Trial: Overview and Study Design,” Radiology, Vol. 258, No. 1, 2011, pp. 243-253. doi:10.1148/radiol.10091808
D. R. Aberle, A. M. Adams, C. D. Berg, J. D. Clapp, K. L. Clingan, I. F. Gareen, D. A. Lynch, P. M. Marcus and P. F. Pinsky, “Baseline Characteristics of Participants in the Randomized National Lung Screening Trial,” Journal of the National Cancer Institute, Vol. 102, No. 23, 2010, pp. 1771-1779. doi:10.1093/jnci/djq434
D. R. Aberle, A. M. Adams, C. D. Berg, W. C. Black, J. D. Clapp, R. M. Fagerstrom, I. F. Gareen, C. Gatsonis, P. M. Marcus and J. D. Sicks, “Reduced Lung-Cancer Mortality with Low-Dose Computed Tomographic Screening,” New England Journal of Medicine, Vol. 365, No. 5, 2011, pp. 395-409. doi:10.1056/NEJMoa1102873
T. V. Colby, M. Koss and W. D. Travis, Eds., “Tumors of Lower Respiratory Tract,” 3rd Edition, Armed Forces Institute of Pathology, Washington, 1995.
K. M. Kerr, “Pulmonary Preinvasive Neoplasia,” Journal of Clinical Pathology, Vol. 54, No. 4, 2001, pp. 257-271. doi:10.1136/jcp.54.4.257
A. K. Greenberg, H. Yee and W. M. Rom, “Preneoplastic Lesions of the Lung,” Respiratory Research, Vol 3, No. 1, 2002, p. 20. doi:10.1186/rr170
J. Hung, S. Lam, J. C. LeRiche and B. Palcic, “Autofluorescence of Normal and Malignant Bronchial Tissue,” Lasers Surgery Medicine, Vol. 11, No. 2, 1991, pp. 99-105. doi:10.1002/lsm.1900110203
S. Lam, C. MacAulay and B. Palcic, “Detection and Localization of Early Lung Cancer by Imaging Techniques,” Chest, Vol. 103, No. 1, 1993, pp. 12S-14S.
E. Edell, S. Lam, H. Pass, Y. E. Miller, T. Sutedja, T. Kennedy, G. Loewen, R. L. Keith and A. Gazdar, “Detection and Localization of Intraepithelial Neoplasia and Invasive Carcinoma Using Fluorescence-Reflectance Bronchoscopy: An International, Multicenter Clinical Trial,” Journal of Thoracic Oncology, Vol. 4, No. 1, 2009, pp. 49-54.
F. R. Hirsch, S. A. Prindiville, Y. E. Miller, W. A. Franklin, E. C. Dempsey, J. R. Murphy, P. A. Bunn Jr. and T. C. Kennedy, “Fluorescence versus White-Light Bronchoscopy for Detection of Preneoplastic Lesions: A Randomized Study,” Journal of the National Cancer Institute, Vol. 93, No. 18, 2001, pp. 1385-1391. doi:10.1093/jnci/93.18.1385
C. Black, R. de Verteuil, S. Walker, J. Ayres, A. Boland, A. Bagust and N. Waugh, “Population Screening for Lung Cancer Using Computed Tomography, Is There Evidence of Clinical Effectiveness? A Systematic Review of the Literature,” Thorax, Vol. 62, No. 2, 2007, pp. 131-138. doi:10.1136/thx.2006.064659
G. Loewen, N. Natarajan, D. Tan, E. Nava, D. Klippenstein, M. Mahoney, M. Cummings and M. Reid, “Autofluorescence Bronchoscopy for Lung Cancer Surveillance Based on Risk Assessment,” Thorax, Vol. 62, No. 4, 2007, pp. 335-340. doi:10.1136/thx.2006.068999
S. Lam, T. Kennedy, M. Unger, Y. E. Miller, D. Gelmont, V. Rusch, B. Gipe, D. Howard, J. C. LeRiche, A. Coldman, et al., “Localization of Bronchial Intraepithelial Neoplastic Lesions by Fluorescence Bronchoscopy,” Chest, Vol. 113, No. 3, 1998, pp. 696-702. doi:10.1378/chest.113.3.696
C. I. Henschke, D. I. McCauley, D. F. Yankelevitz, D. P. Naidich, G. McGuinness, O. S. Miettinen, D. Libby, M. Pasmantier, J. Koizumi, N. Altorki, et al., “Early Lung Cancer Action Project: A Summary of the Findings on Baseline Screening,” Oncologist, Vol. 6, No. 2, 2001, pp. 147-152. doi:10.1634/theoncologist.6-2-147
S. Sone, F. Li, Z. G. Yang, T. Honda, Y. Maruyama, S. Takashima, M. Hasegawa, S. Kawakami, K. Kubo, M. Haniuda, et al., “Results of Three-Year Mass Screening Programme for Lung Cancer Using Mobile Low-Dose Spiral Computed Tomography Scanner,” British Journal of Cancer, Vol. 84, No. 1, 2001, pp. 25-32. doi:10.1054/bjoc.2000.1531
B. Lam, M. P. Wong, S. L. Fung, D. C. Lam, P. C. Wong, T. Y. Mok, F. M. Lam, M. S. Ip, C. G. Ooi and W. K. Lam, “The Clinical Value of Autofluorescence Bronchoscopy for the Diagnosis of Lung Cancer,” European Respiratory Journal, Vol. 28, No. 5, 2006, pp. 915-919. doi:10.1183/09031936.06.00131405
T. Nawa, T. Nakagawa, S. Kusano, Y. Kawasaki, Y. Sugawara and H. Nakata, “Lung Cancer Screening Using Low-Dose Spiral CT: Results of Baseline and 1-Year Follow-Up Studies,” Chest, Vol. 122, No. 1, 2002, pp. 15-20. doi:10.1378/chest.122.1.15
B. J. Venmans, T. J. van Boxem, E. F. Smit, P. E. Postmus and T. G. Sutedja, “Outcome of Bronchial Carcinoma in Situ,” Chest, Vol. 117, No. 6, 2000, pp. 1572-1576. doi:10.1378/chest.117.6.1572
D. A. Cortese, P. C. Pairolero, E. J. Bergstralh, L. B. Woolner, M. A. Uhlenhopp, J. M. Piehler, D. R. Sanderson, P. E. Bernatz, D. E. Williams, W. F. Taylor, et al., “Roentgenographically Occult Lung Cancer. A Ten-Year Experience,” Journal of Thoracic Cardiovascular Surgery, Vol. 86, No. 3, 1983, pp. 373-380.
F. Hirsch, P. Bunn Jr., H. Kato and J. Mulshine, Eds., “Textbook of Prevention and Detection of Early Lung Cancer,” Taylor and Francis, New York, 2006.
A. M. McWilliams, J. R. Mayo, M. I. Ahn, S. L. MacDonald and S. C. Lam, “Lung Cancer Screening Using Multi-Slice Thin-Section Computed Tomography and Autofluorescence Bronchoscopy,” Journal of Thoracic Oncology, Vol. 1, No. 1, 2006, pp. 61-68. doi:10.1097/01243894-200601000-00012