Early Detection of Lung Cancer Using CT Scan and Bronchoscopy in a High Risk Population

Background: Computed tomography (CT) and bronchoscopy have been shown to improve the detection rates of peripheral and central lung cancers (LC), respectively. However, the performance of the combination of CT and bronchoscopy in detecting LC, in high-risk patients, is not clear. Patients & Methods: This prospective study included 205 high-risk patients with a history of at least 2 of the following risk factors: 1) heavy smoking; 2) aero-digestive cancer; 3) pulmonary asbestosis or; 4) chronic obstructive pulmonary disease. Patients were offered chest X-ray, sputum cytology, conventional white-light followed by autofluorescence bronchoscopy (WL/AFB) and low-dose spiral CT both at baseline and follow-up visits. Results: Seven patients (3.4%) were diagnosed with LC or carcinoma in-situ (CIS) at baseline: CT evaluation detected 5 LC/CIS, while WL/AFB evaluation also identified 5 LC/CIS, 2 of which were not detected on CT. Six (85%) of these baseline lesions were early stage (0/IA). The relative-sensitivity of CT with WL/ AFB was 40% better than CT alone. By four year follow-up, 20 patients (9.8%) were diagnosed with LC/CIS. CT with WL/AFB detected 19 cases (95%), whereas CT alone detected 15 cases (75%). Conclusion: Bimodality surveillance with spiral CT and WL/AFB can improve the detection of early stage LCs among high-risk patients.