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First published online on May 15, 2007
Chest, doi:10.1378/chest.06-2794
doi:10.1378/chest.06-2794
(Chest. 2007; 131:1794-1799)
© 2007 American College of Chest Physicians
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A Pilot Study of Narrow-Band Imaging Compared to White Light Bronchoscopy for Evaluation of Normal Airways and Premalignant and Malignant Airways Disease*

Brad D. Vincent, MD; Mostafa Fraig, MD and Gerard A. Silvestri, MD, FCCP

* From the Department of Internal Medicine, Division of Pulmonary and Critical Care, Allergy and Sleep Medicine (Drs. Vincent and Silvestri), and Department of Cellular and Molecular Pathology (Dr. Fraig), Medical University of South Carolina, Charleston, SC.

Correspondence to: Gerard A. Silvestri, MD, FCCP, 96 Jonathan Lucas St, Suite 812 CSB, Charleston, SC 29425; e-mail: silvestri{at}musc.edu

Abstract

Background: The objectives of this study were to characterize the appearance of normal, dysplastic, and frankly malignant airway lesion appearance under narrow-band imaging (NBI), and to determine if NBI, when used in conjunction with white light (WL) bronchoscopy, could improve detection of dysplasia and malignancy.

Patients and methods: This was a prospective, partially blinded study at a university teaching hospital. Bronchoscopy was performed on 22 patients with known or suspected bronchial dysplasia or malignancy. Full airway examination was performed first under WL bronchoscopy and then under NBI. Directed endobronchial biopsies of likely dysplastic, malignant, and normal (control) areas were then performed and sent for examination by a pathologist blinded to the gross description of the lesion. Pathology interpretations were then compared to the corresponding WL and NBI images.

Results: There were one malignant and four dysplastic lesions in 22 patients detected by NBI when findings by WL imaging were considered normal. In cases when the WL appearance was abnormal, NBI did not improve the diagnostic yield. The increased rate of detection of dysplasia and malignancy by NBI was statistically significant (p = 0.005).

Conclusion: NBI identified dysplasia or malignancy that was not detected by WL inspection in 23% of subjects. Further studies are needed to determine the efficacy of NBI in detection of premalignant airways lesions in an at-risk population.

Key Words: bronchial dysplasia • carcinoma in situ • interventional bronchoscopy • lung cancer • malignancy • narrow-band imaging • white-light bronchoscopy






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