Background: Conventional bronchoscopy in the identification of preneoplasias and carcinoma in situ (CIS) has been inadequate to date. Tissue autofluorescence was found to differentiate normal mucosa from dysplastic or carcinomatous bronchial mucosa. This principle resulted in the development of the LIFE System (Light Imaging Fluorescence Endoscope, Xillix Techn., Vancouver, BC), now in routine use worldwide at 35 centres. In a prospective multicentric study in North America the relative sensitivity for diagnosing intraepithelial neoplasias of combined white light (WLB) and LIFE bronchoscopy in 173 at-risk patients was 6.3 as compared to WLB alone. A similar European multicentric study will be completed by spring of 1998.
Patients and results: We report on our experience with the routine use of the LIFE System over 23 months. 194 examinations (165 patients) were performed. Moderate to severe dysplasias and in situ carcinomas were diagnosed with a relative sensitivity of 2.7 by the combined WLB-LIFE examination as compared to WLB alone.
Conclusion: Autofluorescence bronchoscopy as a routine investigation without need of photosensitizers in patients with a high risk for lung cancer can lead to a substantial increase in the detection rate of CIS and moderate to severe dysplasias compared to white light bronchoscopy alone.