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Tracey L. Weigel
Valerie W. Rusch
Robert J. Ginsberg
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Ann Thorac Surg 2001;71:967-970
© 2001 The Society of Thoracic Surgeons

Original article: general thoracic

Postoperative fluorescence bronchoscopic surveillance in non–small cell lung cancer patients

Tracey L. Weigel, MDa, Pamela J. Kosco, RN, MPHa, Sanja Dacic, MD, PhDb, Valerie W. Rusch, MDa, Robert J. Ginsberg, MDa, James D. Luketich, MDc

a Thoracic Surgery Service, Memorial Sloan-Kettering Cancer Center, New York, New York, USA
b Department of Pathology, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, USA
c Section of Thoracic Surgery, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, USA

Address reprint requests to Dr Weigel, Thoracic Surgery Service, Memorial Sloan-Kettering Cancer Center, 1275 York Ave, New York, NY 10021
e-mail: weigelt{at}mskcc.org

Presented at the Poster Session of the Thirty-sixth Annual Meeting of The Society of Thoracic Surgeons, Fort Lauderdale, FL, Jan 31–Feb 2, 2000.

Background. Second lung primaries occur at a rate of 1% to 3% per patient-year after complete resections for non–small cell lung carcinoma (NSCLC). Fluorescence bronchoscopy appears to be a sensitive tool for surveillance of the tracheobronchial tree for early neoplasias.

Methods. Patients who were disease-free after complete resection of a NSCLC were entered into a fluorescence bronchoscopy surveillance program. All suspicious lesions were biopsied along with two areas of normal mucosa to serve as negative controls.

Results. A total of 73 fluorescence bronchoscopies were performed after conventional bronchoscopy in 51 patients at a median of 13 months postresection. The majority (46 of 51) of patients had stage I or II NSCLC, whereas 10% (5 of 51) had stage IIIA. Three intraepithelial neoplasias and one invasive carcinoma were identified in 3 of 51 patients (6%), all current or former smokers. Of the four lesions identified, three were in the 20 patients with prior squamous cell carcinomas. No intraepithelial neoplasias were identified by white-light bronchoscopy, whereas two of three were detected by fluorescence examination. The one invasive cancer detected was apparent on both white-light and fluorescence bronchoscopic examinations.

Conclusions. Surveillance with fluorescence bronchoscopy identified lesions in 6% of postoperative NSCLC patients thought to be disease-free. Patients with prior squamous cell carcinomas appear to be a population that may warrant future prospective study of postoperative fluorescence bronchoscopic surveillance.




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