Does addition of endobronchial ultrasound improves the classification of suspicious lesions detected by autofluorescence bronchoscopy?

ABSTRACT

Autofluorescence bronchoscopy [AFB] may improve sensitivity at the cost of specificity when it is used to identify suspicious bronchial mucosal lesions not seen by conventional white light bronchoscopy. Thus, it seems useful to study these lesions additionally with endobronchial ultrasound [EBUS] for further classification of dignity of suspicious lesions aiming in improving the positive predictive value [PPV] of AFB. This study aims to answer the following question Does addition of EBUS improves the classification of suspicious lesions detected by AFB? Fifty five subjects with suspected lung cancer referred for AFB examination for different indications were recruited for this study. Rigid and Fiberoptic bronchoscopic examination were done followed by AFB then EBUS and finally samples from suspicious sites were taken for histopathological examination. The addition of EBUS to AFB improves PPV from 72.7% in AFB alone to 100% in AFB+EBUS in case of benign suspicious lesions detected by AFB with a negative predicted value [NPV] of 60% and with a sensitivity and specificity of 75% and 100% respectively for AFB+EBUS. While EBUS addition to AFB improves PPV from 60.6% in AFB alone to 95.2% in AFB+EBUS in case of malignant suspicious lesions detected by AFB with a NPV of 100% and with a sensitivity and specificity of 100% and 92% respectively for AFB+EBUS. Thus, the addition of EBUS improves the classification of suspicious lesions detected by AFB with its great implication on further patient management and combining AFB [for tumor localization] to EBUS [for depth estimation] may provide a reliable method of staging and choice of treatment modality of lung cancer