Advanced Bronchoscopic Techniques Significantly Improve Diagnosis and Staging of Lung Cancer

October 29, 2007 (Los Angeles) — Advanced bronchoscopic techniques such as autofluorescence are significantly improving the diagnosis and staging of lung cancer, Michael Simoff, MD, senior staff physician in pulmonary and critical care medicine and director of the bronchoscopy and interventional pulmonary program at Henry Ford Hospital, in Detroit, Michigan, told attendees at the American Society for Therapeutic Radiology and Oncology (ASTRO) 49th Annual Meeting.
Dr. Simoff said that autofluorescence appears to be more effective than white-light bronchoscopy at detecting subtle changes and can highlight areas that otherwise would be difficult to see clearly.
Dr. Simoff outlined several other techniques that improve the diagnostic yield in lung cancer. Endobronchial ultrasound, which allows the endoscopist to look beyond the airways, is increasingly used as a diagnostic tool, Dr. Simoff added. Meanwhile, transbronchial needle aspiration is "one of the best techniques for doing initial staging but is underused," he said.
Dr. Simoff told his audience that endobronchial ultrasound-guided transbronchial needle aspiration yielded a diagnosis in 95.5% of cases and was able to access lymph nodes that could not otherwise be reached. The technique is particularly effective at diagnosing malignancy in lymph nodes of less than 1 cm. Simoff said he has found that 22% of such nodes diagnosed as negative through positron emission tomography–computed tomography (PET-CT) are in fact positive, but endoscopists would have no way of knowing this without advanced techniques.
Session attendee Bulent Aydogan, PhD, assistant professor of medical physics in the department of radiation and cellular oncology at the University of Chicago in Illinois, commented to Medscape Oncology after Dr. Simoff's presentation that techniques such as endobronchial ultrasound "are going to change the way we treat lung cancer patients, particularly [those with] small peripheral lung cancers."
Using techniques such as those outlined by Dr. Simoff, "we are going to be able to pinpoint exactly where the small peripheral tumor is and better target, localize, and deliver radiation therapy to these tumors," Dr. Aydogan added.
Dr. Simoff noted that another technique, confocal microendoscopy, "is something I'm very interested in and excited about."
Dr. Simoff said advanced diagnostic techniques are moving the state of the art toward the optical biopsy. In the future, the goal is treatment without surgery, Dr. Simoff added. He said that physicians at Henry Ford Hospital expect to be able to perform precise radiosurgical techniques within 5 years.
Neither Dr. Simoff nor Dr. Aydogan have disclosed any relevant financial relationships.
American Society for Therapeutic Radiology and Oncology 49th Annual Meeting. Presented October 28, 2007.