nurdan kalkan, gülşah günlüoğlu, sedat altın, erdoğan Çetinkaya, nurdan Şimşek
DESCRIPTION
EFFECT OF AUTOFLORESCENT BRONCHOSCOPY TO DETECTING NEW CANCER OR PREMALIGN LESION IN PATIENTS OPERATED DUE TO LUNG CANCER. Nurdan Kalkan, Gülşah Günlüoğlu, Sedat Altın, Erdoğan Çetinkaya, Nurdan Şimşek Yedikule Chest Diseases and Thoracic Surgery Center. Lung cancer. Early diagnosis - PowerPoint PPT PresentationTRANSCRIPT
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EFFECT OF AUTOFLORESCENT BRONCHOSCOPY TO DETECTING NEW CANCER OR PREMALIGN LESION IN PATIENTS OPERATED DUE TO LUNG
CANCER
Nurdan Kalkan, Gülşah Günlüoğlu, Sedat Altın, Erdoğan Çetinkaya, Nurdan Şimşek
Yedikule Chest Diseases and Thoracic Surgery Center
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Lung cancer
Early diagnosis Endobronchial therapy Better survival
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Early diagnosis
Molecular genetic abnormalities, Metaplasia, Displasia, CIS, İnvasive carcinoma
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Çok erken tanı
Sputum cytology
Invasive carcinoma Radiographs
Bronchoscopy Premalign lesion
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White Light Bronchoscopy(WLB)
Nodular, polypoid 2mm Mucosal >5mm CIS under basal membran in 75% of patients
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Autoflorescent Bronchoscopy(AFB)
Light on normal mucosa Reflection Absorbtion can seen Dispersion
Florescence can not seen
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Florescence
Structural elements of tissue (collogen, elastin)
Cellular metabolites (NADH, flavines) Aromatic aminoacides, porfirines,
lipopigments
Decreases at pathologic tissue
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Florescence
Potentialisation of the florescence
( with hematoporfirine derives)
Detecting autoflorescence
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Autoflorescence
The rate of detected premalign lesion is more than with white light
(Venmans, Lam, O’Neill..)
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Study
In operated patients due to lung cancer
(who encountered with carcinogens)
To detecting existence of premalign lesion
(no invasive carcinoma)
Effect of AFB when compared with WLB
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Patients
40 patients operated on due to lung cancer 39 male, 1 female, with mean age of 58,1 Cigarette 57 p.p. year 8 ex-smoker
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Procedure
At same session Experienced bronchoscopyst Biopsies from bronchial stump in all
patients(40) Biopsies from other pathological seen areas Histopathological examination Comparing sensitivities and spesivicities of
WLB and AFB
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Patients
31% epidermoid carcinoma 72,5% lobectomy 42% stage 2 17,5% stage 3A 37,5% adjuvant therapy Mean time between surgery and
bronchoscopy is 21,4 month
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Bronchial stump areas
WLB: 2 pathologic areas 2 cancer
AFB: 6 pathologic areas 2 cancer, 4 normal
Pathologic exam: 5 pathologic areas 2 cancer, 3 metaplasia
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Bronchial stump areas
WLB:
Sensitivity: 40%
FP:0
AFB:
Sensitivity:40%
FP:66%
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Areas other than bronchial stump
WLB: 2 pathologic areas:
– 1 cancer, – 1 metaplasia
1 low grade, 1 high grade
AFB: 8 pathologic areas:
– 1 cancer – 1 high displasia, – 3 metaplasia,– 3 normal
3 low grade, 2 high grade
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Areas other than bronchial stump
WLB:
Sensitivity:40%
FP:0
AFB:
Sensitivity:100%
FP:37%
Relative sensitivity of AFB is more than WLB 2,5 times
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All biopsies
WLB:
Sensitivity:40%
FP:0
AFB:
Sensitivity:70%
FP:50%
Relative sensitivity of AFB is more than WLB 1,75 times
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Low grade lesions
(metaplasia, low grade displasia)
Sensitivity of WLB: 17%(1/6) Sensitivity of AFB : 50%(3/6)
Relative sensitivity of AFB is more than WLB 2,94 times
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Yüksek grade
(moderate and high grade displasia, CIS,
carcinoma)
Sensitivity of WLB: %75 (3/4) Sensitivity of AFB : %100 (4/4)
Relative sensitivity of AFB is more than WLB 1,33 times
Number of patients, number of invasive carcinomas
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Other results
There is no effect of tumor type on developing new lesion
There is no effect of surgical procedure type on developing new lesion
There is no effect of continue to smoking on developing new lesion
AFB could detect all lesions detected by WLB
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False positivity of AFB
İnflammation, Effect of surgery on bronchial stump areas, İndividual degree of florophores on normal
mucosa, Bronchoscopist and patholog factors, Molecular carcinonogenesis Reported 1/3 Have not bad effect except need of additional biopsy
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False negativity of AFB
Changes secondary to surgery Folding of mucosa Longutidunal swelling of membranous side
may hide small lesions Bronchoscopist and patholog factors
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Conclusion
SENSITIVITY OF AFB IS MORE THAN WLB TO DIAGNOSING NEW CANCER OR PREMALIGN LESIONS IN OPERATED NSCLC PATIENTS