At the moment only early detection of lung cancer offers a good prognosis for the patients. Conventional white light endoscopy is mostly insufficient for early diagnosis. Therefore we
developed a system of fluorescence diagnosis using 5-aminolaevulinic acid (ALA)
exogeneously applied. As precursor of the heme synthesis it is metabolized to protoporphyrin
IX –  a red fluorescent substance. Therefore protoporphyrin IX accumulates in tumorous and
premalignant tissue, and can be directly visualized by fluorescence bronchoscopy. Excitation
with blue light (380–435 nm) causes a red fluorescence, which can be detected after filtering
most of the blue component with the naked eye or a camera system. After earlier work with
laser systems and cold light sources we now use the system D-Light AF for the fluorescence
diagnosis using ALA-induced protoporphyrin IX fluorescence.

Rudolf M. Huber

F. Gamarra

H. Hautmann

K. Häußinger

S. Wagner

M. Castro

R. Baumgartner

5-Aminolaevulinic Acid (ALA) for the Fluorescence Detection of Bronchial Tumors

We present a newly developed diagnostic system combining a conventional light source (white light mode and two different fluorescence excitation modes), a bronchoscope and optionally a highly sensitive camera (Baumgartner et al., Photochem. Photobiol. 1987; 46(5): 759–763). Routine diagnostics can be performed with the autofluorescence bronchoscopy (AFB) and the white light bronchoscopy (WLB) in one diagnostic procedure. The image is visible directly with the naked eye. The system was evaluated in a pilot study including 60 patients. Two hundred and sixty-four biopsies were taken to detect premalignant and malignant findings (Stanzel et al., Contribution to 10th World Congress for Bronchology, June 1998). The sensitivity of the combination of WLB and AFB was 2.8 times higher than that of the conventional WLB. The specificity decreased from 94% (WLB) to 89% (WLB + AFB). The results of this preliminary pilot study are being confirmed in a multicenter study, which will begin at seven European centers.

F. Stanzel

R. M. Huber

J. Pichler

H. Stepp

Autofluorescence Detection of Bronchial Tumors With the D-Light/AF

Recently several endoscopic fluorescence detection systems have been developed. In some ofthem, laser light was used for the excitation of autofluorescence, and sophisticated techniques were also necessary to amplify the fluorescence signal as well.The result of fluorescence diagnosis using a simple system with a conventional Xenon lampexcitation and an image intensifier is reported. The respective results of sensitivity andpositive predictive values of cancer plus dysplasia were 66&#37;, and 62&#37; by standardbronchoscopy and 92&#37; and 88&#37; by the newly developed autofluorescence system. In thispaper, developed endoscope for detection of tissue/mucosal autofluorescence without theapplication of any photosensitizing agents or use of any lasers is evaluated.

Masatoshi  Kakihana

Kim Kyong Il.

Tetsuya  Okunaka

Kinya  Furukawa

Takashi  Hirano

Chimori  Konaka

Harubumi  kato

Yoshiro  Ebihara

Early Detection of Bronchial Lesions Using System of Autofluorescence Endoscopy (SAFE) 1000

The increase in the detection rate for premalignant changes of bronchial epithelium was studied in 56 symptom-free volunteers from the risk group of Czech uranium miners &#40;mean age 50.69 years, mean WLM 21.06 &#40;1 Working Level Month is equal to the absorption of latent energy of 2.08 &#215; 10&#8211;5 J/m3 in one month, i.e. 170 working hours&#41;&#41; by the additional employment of the System of Autofluorescence Endoscopy &#40;SAFE-1000 Pentax&#41; to conventional white-light bronchoscopy, comparing results with those of bronchial biopsy histopathology examination. Histopathology using hematoxylin and eosin staining confirmed intraepithelial neoplasias in 15 areas in 10 persons. White-light bronchoscopy sensitivity was 21.05&#37;, and specificity 93.7&#37; which an autofluorescence bronchoscopy sensitivity was 78.95&#37; and specificity 81.89&#37;.

T.  Horvath

M.  Horvathova

F.  Salajka

B.  Habanec

L.  Foretova

J.  Kana

H.  Koukalova

P.  Pafko

F.  Wurst

E.  Novotna

J.  Pecina

V.  Vagunda

R.  Vrbacky

R.  Talac

H.  Coupkov&#225;

Z.  Pacovsky

Detection of Bronchial Neoplasia in Uranium Miners by Autofluorescence Endoscopy (SAFE-1000)

The performance of the Lung Imaging Fluorescence Endoscope &#40;LIFE&#41; system was compared with conventional bronchoscopy in 158 patients: 68 patients with invasive cancer, 42 patientswith abnormal sputum cytology findings &#40;12 early cancer and 26 dysplasia&#41;, 17 cases withresected lung cancer and 31 smokers with symptoms. The respective results of conventionalbronchoscopy and LIFE for detection of dysplasia were; sensitivity 52&#37; and 90&#37; &#40;biopsybasis&#41;, 62&#37; and 92&#37; &#40;patient basis&#41;. Fluorescence bronchoscopy may be an importantadjunct to conventional bronchoscopy to improve the localization of subtle lesions ofbronchus.

N.  Ikeda

H.  Honda

T.  Katsumi

T.  Okunaka

K.  Furukawa

T.  Tsuchida

K.  Tanaka

T.  Onoda

T.  Hirano

M.  Saito

N.  Kawate

C.  Konaka

H.  Kato

Y.  Ebihara

Early Detection of Bronchial Lesions Using Lung Imaging Fluorescence Endoscope

The aim of the study was to determine whether use of fluorescence bronchoscopy improves the detection of preinvasive neoplastic bronchial lesions. The data of all patients who underwent fluorescence bronchoscopy and in whom bronchial biopsies were taken, were analyzed. Most patients were at risk for preinvasive lesions. A total of 174 bronchoscopies were performed in 95 patients. Of the 681 representative biopsies, 31 were found to be moderate dysplastic, 39 were found to be severe dysplastic and 9 exhibited carcinoma in situ. These 79 preinvasive lesions were found in 34 patients. The respective results of fluorescence bronchoscopy in addition to conventional bronchoscopy and of conventional bronchoscopy alone for detection of preinvasive lesions were: sensitivity 85&#37; &#40;67&#47;79&#41; and 59&#37; &#40;47&#47;79&#41;; specificity 60&#37; &#40;351&#47;581&#41; and 85&#37; &#40;493&#47;581&#41;; positive predictive values of 23&#37; &#40;67&#47;297&#41; and 35&#37; &#40;47&#47;135&#41;; negative predictive values of 97&#37; &#40;351&#47;363&#41; and 94&#37; &#40;493&#47;525&#41;. A separate analysis of only the first bronchoscopy of each patient showed similar results. Results of fluoresence bronchoscopy were better in the second part of the patient group. We conclude that after a learning period fluorescence bronchoscopy can increase the yield of finding preinvasive neoplastic lesions when used in addition to conventional bronchoscopy.

Ben J. W. Venmans

Ton J. M. Van Boxem

Egbert F. Smit

Pieter E. Postmus

Tom G. Sutedja

Results of Two Years Expenience with Fluorescence Bronchoscopy in Detection of Preinvasive Bronchial Neoplasia

A new autofluorescence &#40;AF&#41; system for bronchoscopy that operates as compact as aconventional white light bronchoscopy system is described. The system is also capable of whitelight illumination and excitation of aminolevulinic acid &#40;ALA&#41; induced fluorescence. Changing between white light and &#40;auto-&#41; fluorescence mode is easy and always possible. Broad band excitation with blue light &#40;AF: 380&#8211;460 nm; ALA 380&#8211;440 nm&#41; delivers highintensity illumination at the distal end of the bronchoscope &#40;AF typically 50 mW&#41;. A specialoptical observation technique makes the AF directly visible to the eye instead of indirecttechniques used in other AF systems. A compact &#40;160 g&#41;and sensitive &#40;typically 0.2 lux&#41;camera can be used for documentation.

Martin  Leonhard

New Incoherent Autofluorescence/Fluorescence System for Early Detection of Lung Cancer

It is a well known fact that light emitted at a specific wavelength induces fluorescence in the
human body. This kind of fluorescence is called autofluorescence. The application of
autofluorescence diagnosis, on the other hand, is a more complicated system designed to
detect faint autofluorescence inherent in tissues&#x2F;cells. We have adopted this autofluorescence
diagnosis method and developed a new autofluorescence endoscope imaging system called
the SAFE-1000. Normal mucosa emitting autofluorescence appears green on the monitor,
while abnormal mucosa shows a dark image caused by the lack of autofluorescence.

Rensuke Adachi

Tetsuya Utsui

Koichi Furusawa

Development of the Autofluorescence Endoscope Imaging System

Background Second lung primaries occur at a rate of 2&#37; per patient per year after curative resection for non-small cell lung carcinoma (NSCLC). The aim of this study was toevaluate the role of fluorescence bronchoscopy using the Xillix&#174; LIFE-Lung FluorescentEndoscopy SystemTM (LIFE-Lung system) in the surveillance of patients for secondNSCLC primaries after resection or curative photodynamic therapy (PDT).Methods NSCLC patients who were disease-free following resection or endobronchialPDT were identified and recruited to participate in a LIFE bronchoscopy surveillanceprogram. All suspicious areas were biopsied; areas of apparent normal mucosa served asnegative controls. Biopsy specimens were reviewed by a single pulmonary pathologist.Results Thirty-six patients underwent 53 surveillance LIFE bronchoscopies and 6/112 biopsies revealed intraepithelial neoplasia (IEN) or invasive carcinoma in 6/36(17&#37;) of patients. The overall relative sensitivity of LIFE versus conventional bronchoscopywas 165&#37; with a negative predictive value of 0.96, for the post-resection subset ofpatients these values increased to 200&#37; and 0.97, respectively.Conclusions Surveillance LIFE bronchoscopy identified intraepithelial or invasive lesions in 17&#37; of patients previously thought to be disease-free. These data support futuremulticenter trials on fluorescence bronchoscopic surveillance of NSCLC patients aftercurative surgical resection or PDT.

Tracey Lee Weigel

Pamela J. Kosco

Sanja  Dacic

Samuel  Yousem

James D. Luketich

Fluorescence Bronchoscopic Surveillance in Patients With a History of Non-Small Cell Lung Cancer

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Diagnostic and Therapeutic Endoscopy - Table of contents 1999

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