Early lung cancer: Methods for detection

Abstract

Although the incidence and death due to lung cancer continue to decline in recent years, lung cancer is still the leading cause of death in North America. For improving lung cancer survival, screening and early detection will be one of the most important clinical practices. Airway assessment techniques beyond white light observation have been accepted in current clinical environment for early endobronchial malignancy detection and surveillance. Autofluorescence bronchoscopy (AFB), narrow band imaging (NBI), and high magnification bronchovideoscope are some of the advanced bronchoscopic imaging techniques capable of detecting preinvasive lesions currently available in clinical practice. These technologies allow to differentiate between pre- and malignant lesions utilizing differential patterns of normal and pathological tissue autofluorescence or vasculature. Endocytoscopy, confocal miniprobe, and Raman spectroscopy are still investigational, but these novel technologies will open a new avenue for more precise evaluation and higher diagnostic yield of very early detection of lung cancer. The technology which received the most attention in interventional pulmonology over the past two decades was the development of endobronchial ultrasound. Endobronchial ultrasound allows advanced assessment of the airway as well as the mediastinum and peripheral lung nodules. The radial probe endobronchial ultrasound (EBUS) allows a more precise evaluation of newly detected preinvasive lesions within the airway. Optical coherence tomography is another new technology for more precise observation of endobronchial structures. This chapter will review the advanced bronchoscopic imaging technologies for detection of early lung cancer.