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Cigarette Smoking, Preinvasive Bronchial Lesions, and Autofluorescence Bronchoscopy^*

^* From the Lung Cancer Research Group (Drs. Moro-Sibilot, Lantuejoul, E. Brambilla, and C. Brambilla), Institut National de la Santé et de la Recherche Médicale, Institut A. Bonniot, La Tronche, France; Département de Médecine Aigue Specialisée. Pneumologie (Drs. Jeanmart and Arbib), Hôpital Albert Michallon, Grenoble, France; and Laboratoire de Pathologie Cellulaire (Dr. Laverrière), Centre Hospitalier Universitaire de Grenoble, France.

Correspondence to: Denis Moro-Sibilot, MD, DMAS Pneumologie, Hôpital Albert Michallon, BP217 38043 Grenoble Cedex 9, France

Study objectives: Autofluorescence bronchoscopy (AFB), when used as an adjunct to standard white light bronchoscopy (WLB), enhances the bronchoscopist’s ability to localize small neoplastic lesions, especially intraepithelial lesions. The current study was undertaken in order to define the population in which the rate of detection is higher using AFB.

Design and patients: Two hundred forty-four consecutive patients, who were symptomatic smokers or patients who previously had been treated for lung cancer or head and neck cancers, underwent WLB and AFB. All patients with endoscopic abnormalities underwent biopsies. Data concerning smoking history were prospectively registered.

Results: We report the prevalence of high-grade or invasive lesions at the time of examination. On a lesion-by-lesion analysis, 92 low-grade lesions, 42 high-grade lesions (ie, moderate dysplasia, severe dysplasia, and carcinoma in situ), and 39 invasive carcinomas were diagnosed. There was no effect of age, gender, and age at smoking initiation on the prevalence of preinvasive or invasive lesions. The 10 patients who previously had undergone surgery for lung cancer and exhibited high-grade preinvasive lesions had a history of carcinoma of the epidermoid histologic type (p = 0.01). These 10 patients displayed multiple lesions in the bronchial tree (mean No. of lesions, 1.8 per patient). In current smokers, the prevalence of high-grade or invasive lesions were both related to the number of pack-years smoking had occurred (p = 0.01) and to the duration of smoking (p = 0.01). In contrast, the prevalence of preinvasive lesions in former smokers was related to a history of epidermoid carcinoma.

Conclusions: AFB should be recommended in patients with a history of epidermoid carcinomas of the lung. Current smokers with a prolonged smoking history appear to comprise a population in which the rate of detection of preneoplastic lesions is high with AFB.

Key Words: autofluorescence bronchoscopy • early detection • occult lung cancer

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