A fluorescence imaging system &#40;Xillix LIFE &#8211; Lung Fluorescence Endoscopy system&#41; usingfluorescence for the accurate diagnosis and early detection of lesions through an endosocopehas been developed. This system has applied an optical diagnostic technology to functionallydiagnose lesions which have been difficult to morphologically recognize or are occult withconventional endoscope. The benefit of this system in the diagnosis of lung cancer has alreadybeen confirmed in the US and Japan, and feasibility of the system in the gastric intestinal fieldhas also been evaluated.

S.  Takehana

M.  Kaneko

H.  Mizuno

Endoscopic Diagnostic System Using Autofluorescence

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

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 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

Autofluorescence spectra of neoplastic tissues have been reported to be significantly different
from those of normal tissues when excited by blue or violet light. From this concept, a light-induced
autofluorescence endoscopic imaging system for gastrointestinal mucosa (LIFE-GI;
Xillix, Canada and Olympus, Japan) has been newly developed and the clinical evaluation of
the prototype system has been conducted in hospitals in Canada, Netherlands and Japan.We examined the clinical usefulness of the prototype LIFE-GI system for the detection of
gastrointestinal cancer and high and low grade dysplasia. The LIFE-GI system was also
applied to the early detection of remnant lesions after endoscopic treatment of early gastric
cancer and to the detection of laterally spreading superficial colonic tumors.This system has potential application for the diagnosis of dysplastic lesions and early
cancers in the gastrointestinal tract as an adjunct to ordinary white light endoscopy. This
system, which needs no administration of a photosensitive agent, may be suitable as a
screening method for the early detection of neoplastic tissues.

Tatsuo Ogihara

Haruo Watanabe

Akihiro Namihisa

Osamu Kobayashi

Hiroto Miwa

Nobuhiro Sato

Clinical Experience Using a Real Time Autofluorescence Endoscopy System in the Gastrointestinal Tract

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

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)

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

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

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

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