Autofluorescence bronchoscopy in volunteer asymptomatic smokers.

We assess the sensitivity of autofluorescence bronchoscopy (AFB) compared to that of white light bronchoscopy (WLB) for identification of pre-invasive neoplastic changes of bronchial mucosa in asymptomatic heavy smokers. WLB was performed using a standard flexible fibre-optic bronchoscope, and AFB carried out using the Xillix LIFE Lung((R)) system. Positive AFB images were indicated in the bronchial tree from 51 of the 93 subjects in the study. Biopsies showed epithelial abnormalities in 27 (15 metaplasia, 12 inflammatory changes) of these. WLB showed abnormality in 1 subject but with no pathological changes revealed by cyto-histology. Therefore, the sensitivity of AFB to metaplasia was 75% compared to zero for WLB. AFB yields positive predictive values for metaplastic and overall mucosal changes of 29.4% and 52.9%, respectively. In summary, over 16% of asymptomatic smokers had metaplastic changes in their bronchial mucosa, and AFB proved more sensitive in revealing early changes than WLB.