• Alain Tremblay, Niloofar Taghizadeh, Annette M McWilliams, Paul MacEachern, David R Stather, Kam Soghrati, Serge Puksa, John R Goffin, Kazuhiro Yasufuku, Kayvan Amjadi, Garth Nicholas, Simon Martel, Francis Laberge, Michael Johnston, Frances A Shepherd, Diana N Ionescu, Stefan Urbanski, David Hwang, Jean-Claude Cutz, Harmanjatinder S Sekhon, Christian Couture, Zhaolin Xu, Tom G Sutedja, Sukhinder Atkar-Khattra, Martin C Tammemagi, Ming-Sound Tsao, Stephen C Lam, and Pan-Canadian Early Lung Cancer Study Group.
• Division of Respiratory Medicine, University of Calgary, Calgary, AB, Canada. Electronic address: alain.tremblay@ucalgary.ca.
• Chest. 2016 Nov 1; 150 (5): 1015-1022.

BackgroundLung cancer screening with low-dose CT (LDCT) scan has been demonstrated to reduce lung cancer mortality. Preliminary reports suggested that up to 20% of lung cancers may be CT scan occult but detectable by autofluorescence bronchoscopy (AFB). We evaluated the prevalence of CT scan occult, invasive, and high-grade preinvasive lesions in high-risk participants undergoing screening for lung cancer.MethodsThe first 1,300 participants from seven centers in the Pan-Canadian Early Detection of Lung Cancer Study who had ≥ 2% lung cancer risk over 5 years were invited to have an AFB in addition to a LDCT scan. We determined the prevalence of CT scan and AFB abnormalities and analyzed the association between selected predictor variables and preinvasive lesions plus invasive cancer.ResultsA total of 776 endobronchial biopsies were performed in 333 of 1,300 (25.6%) participants. Dysplastic or higher-grade lesions were detected in 5.3% of the participants (n = 68; mild dysplasia: n = 36, moderate dysplasia: n = 25, severe dysplasia: n = 3, carcinoma in situ [CIS]: n = 1, and carcinoma: n = 4). Only one typical carcinoid tumor and one CIS lesion were detected by AFB alone, for a rate of CT scan occult cancer of 0.15% (95% CI, 0.0%-0.6%). Fifty-six prevalence lung cancers were detected by LDCT scan (4.3%). The only independent risk factors for finding of dysplasia or CIS on AFB were smoking duration (OR, 1.05; 95% CI, 1.02-1.07) and FEV1 percent predicted (OR, 0.99; 95% CI, 0.98-0.99).ConclusionsThe addition of AFB to LDCT scan in a high lung cancer risk cohort detected too few CT occult cancers (0.15%) to justify its incorporation into a lung cancer screening program.Trial RegistryClinicalTrials.gov; No.: NCT00751660; URL: www.clinicaltrials.gov.Copyright © 2016 American College of Chest Physicians. Published by Elsevier Inc. All rights reserved.

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