Low Prevalence of High-Grade Lesions Detected With Autofluorescence Bronchoscopy in the Setting of Lung Cancer Screening in the Pan-Canadian Lung Cancer Screening Study Academic Article uri icon

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abstract

  • BACKGROUND: Lung cancer screening with low-dose CT (LDCT) scan has been demonstrated to reduce lung cancer mortality. Preliminary reports suggested that up to 20% of lung cancers may be CT scan occult but detectable by autofluorescence bronchoscopy (AFB). We evaluated the prevalence of CT scan occult, invasive, and high-grade preinvasive lesions in high-risk participants undergoing screening for lung cancer. METHODS: The first 1,300 participants from seven centers in the Pan-Canadian Early Detection of Lung Cancer Study who had ≥ 2% lung cancer risk over 5 years were invited to have an AFB in addition to a LDCT scan. We determined the prevalence of CT scan and AFB abnormalities and analyzed the association between selected predictor variables and preinvasive lesions plus invasive cancer. RESULTS: A total of 776 endobronchial biopsies were performed in 333 of 1,300 (25.6%) participants. Dysplastic or higher-grade lesions were detected in 5.3% of the participants (n = 68; mild dysplasia: n = 36, moderate dysplasia: n = 25, severe dysplasia: n = 3, carcinoma in situ [CIS]: n = 1, and carcinoma: n = 4). Only one typical carcinoid tumor and one CIS lesion were detected by AFB alone, for a rate of CT scan occult cancer of 0.15% (95% CI, 0.0%-0.6%). Fifty-six prevalence lung cancers were detected by LDCT scan (4.3%). The only independent risk factors for finding of dysplasia or CIS on AFB were smoking duration (OR, 1.05; 95% CI, 1.02-1.07) and FEV1 percent predicted (OR, 0.99; 95% CI, 0.98-0.99). CONCLUSIONS: The addition of AFB to LDCT scan in a high lung cancer risk cohort detected too few CT occult cancers (0.15%) to justify its incorporation into a lung cancer screening program. TRIAL REGISTRY: ClinicalTrials.gov; No.: NCT00751660; URL: www.clinicaltrials.gov.

authors

  • Tremblay, Alain
  • Taghizadeh, Niloofar
  • McWilliams, Annette M
  • MacEachern, Paul
  • Stather, David R
  • Soghrati, Kam
  • Puksa, Serge
  • Goffin, John
  • Yasufuku, Kazuhiro
  • Amjadi, Kayvan
  • Nicholas, Garth
  • Martel, Simon
  • Laberge, Francis
  • Johnston, Michael
  • Shepherd, Frances A
  • Ionescu, Diana N
  • Urbanski, Stefan
  • Hwang, David
  • Cutz, Jean-claude
  • Sekhon, Harmanjatinder S
  • Couture, Christian
  • Xu, Zhaolin
  • Sutedja, Tom G
  • Atkar-Khattra, Sukhinder
  • Tammemagi, Martin C
  • Tsao, Ming-Sound
  • Lam, Stephen C

publication date

  • November 2016

published in