Comparison of autofluorescence imaging bronchoscopy and white light bronchoscopy for detection of lung cancers and precancerous lesions

Yan Wang,^1,* Qing Wang,^2,* Jing Feng,^1,3 Qi Wu<sup>4

1</sup>Respiratory Department of Tianjin Medical University General Hospital, Tianjin, People’s Republic of China; ²Respiratory Department of the First People's Hospital of Kunming, Yunnan, People's Republic of China; ³Division of Pulmonary and Critical Care Medicine, Duke University Medical Center, Durham, NC, USA; ⁴Respiratory Department of Tianjin Haihe Hospital, Tianjin, People’s Republic of China

^*These two authors contributed equally to this work

Background: The purpose of this paper was to compare the sensitivity, specificity, and overall diagnostic performance of autofluorescence imaging bronchoscopy (AFI) versus white light bronchoscopy (WLB) in the detection of lung cancers and precancerous lesions by meta-analysis.
Methods: We performed a literature search using the PubMed and EMBASE databases to identify studies published between March 1991 and March 2012. Article selection, quality assessment, and data extraction were then performed. The pooled sensitivity, specificity, diagnostic odds ratio, and area under the curve of the summary receiver operating characteristic for AFI versus WLB were calculated using Stata version 12.0 software.
Results: Six studies were included in the meta-analysis. The pooled sensitivity of AFI and WLB was 0.89 (95% confidence interval [CI] 0.81–0.94) and 0.67 (95% CI 0.46–0.83) and the pooled specificity of AFI and WLB was 0.64 (95% CI 0.37–0.84) and 0.84 (95% CI 0.74–0.91), respectively. The diagnostic odds ratio for AFI and WLB was 14.5 (95% CI 3.76–55.63) and 10.9 (95% CI 3.12–38.21), and the area under the curve for AFI and WLB was 0.89 (95% CI 0.86–0.92) and 0.85 (95% CI 0.81–0.88), respectively. The pooled positive and negative likelihood ratios were 2.5 (95% CI 1.21–4.97) and 0.17 (95% CI 0.08–0.36) for AFI, and the corresponding values for WLB were 4.3 (95% CI 2.13–8.52) and 0.39 (95% CI 0.21–0.73). The pooled positive likelihood ratio for AFI and WLB was not higher than 10, and the pooled negative likelihood ratio for AFI and WLB was not lower than 0.1.
Conclusion: The sensitivity of AFI is higher than that of WLB, while the specificity of AFI is lower than that of WLB. The overall diagnostic performance of AFI is slightly better than that of WLB in detecting lung cancers and precancerous lesions. AFI should find its place in routine bronchoscopic examination and may improve the diagnostic outcome on endoscopy.

Keywords: autofluorescence imaging bronchoscopy, autofluorescence bronchoscopy, light bronchoscopy, lung cancers, precancerous lesions