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Direct comparison of diagnostic accuracy between autofluorescence bronchoscopy (AFB) and AFB combined with white light bronchoscopy (AFB + WLB) for lung cancer and precancerous lesions: a systematic review and meta-analysis

Date

20 Dec 2015

Session

Poster presentation 2

Presenters

Jianrong Zhang

Citation

Annals of Oncology (2015) 26 (suppl_9): 125-147. 10.1093/annonc/mdv532

Authors

J. Zhang1, J. Wu2, Y. Yang3, H. Liao4, Z. Xu5, Z. Liang6, J. Huang7, L. Jiang1, X. Zou1, Y. Chen1, W. Liang8, J. He1

Author affiliations

  • 1 Thoracic Surgery, The 1st Affiliated Hospital of Guangzhou Medical University, 510120 - Guangzhou/CN
  • 2 Department Of Pathology, The 1st Affiliated Hospital of Guangzhou Medical University, 510120 - Guangzhou/CN
  • 3 Clinical Laboratory, Guangdong General Hospital, 510000 - Guangzhou/CN
  • 4 Respiratory Medicine, The Fifth Affiliated Hospital of Southern Medical University, 510000 - Guangzhou/CN
  • 5 Critical Care Medicine, The 1st Affiliated Hospital of Guangzhou Medical University, 510120 - Guangzhou/CN
  • 6 Neonatology, The Third Affiliated Hospital of Guangzhou Medical University, 510150 - Guangzhou/CN
  • 7 Medical Equipment Section, 3rd Affiliated Hospital of Sun Yat-sen University, 510000 - Guangzhou/CN
  • 8 Department Of Thoracic Oncology, The 1st Affiliated Hospital of Guangzhou Medical University, 510000 - Guangzhou/CN
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Resources

Abstract 978

Aim/Background

For diagnosing lung cancerous and precancerous lesions, autofluorescence bronchoscopy (AFB) presented considerably high sensitivity but low specificity, which may be improved when AFB was combined with white light brochoscopy (AFB + WLB). The aim of this study was to compare the diagnostic performance between AFB and AFB + WLB directly.

Methods

Pubmed, Scopus, Embase, Web of Science, ProQuest, the Cochrane Library and Ovid were searched from inception to Mar 20, 2015, for elegible studies containing sufficient data from both of tehcniques to construct 2 × 2 table with confirmation by histopathology. Pooled sensitivity, specificity, diagnostic odds ratio (DOR) and the area under the receiver-operating characteristic curve (AUC) were estimated by random-effect model. Quality assessment and heterogeneity were assessed.

Results

7 comparative studies involving with 904 patients and 2740 biopsy specimens were included. The summary sensitivity, specificity, DOR and AUC of AFB were 88% (95%CI 65%-97%), 63% (49-75), 12 (3-54) and 77% (73-81) respectively, and those of AFB + WLB were 90% (77-96), 54% (39-68), 11 (4-34) and 78% (74-81). In heterogeneity assessment, study quality (according to QUADAS-2) was indicated as the effect on AFB + WLB data, corresponding P value was 0.01 and I2 was 78% (51-100). However, lower specificity of AFB + WLB (vs AFB) was presented and no significant difference (P < 0.05) for comparison existed among studies with high or moderate&low quality. Same situation was shown in all results of summary and exploratory subgroup analysis.

Subgroup Analysis

Histopathology Tech Sen (%) 95%CI (%) P Spe (%) 95%CI (%) P
INV- > SEV A 86 50-100 0.239 89 80-97 0.629
A + W 91 62-100 79 58-99
INV- > MOD A 95 86-100 0.151 63 45-81 0.178
A + W 96 87-100 60 40-79
CIS- > MOD A 74 34-100 0.109 52 30-75 0.140
A + W 77 43-100 49 23-74
ASD A 75 20-100 0.597 46 17-75 0.173
A + W 91 63-100 23 7-39

INV = Invasive carcinoma CIS = Carcinoma in situ SEV = Severe dysplasia MOD = Moderate dysplasia ASD = Angiogenic Squamous Dysplasia.

Conclusions

Insufficient evidence indicated the diagnostic performance of AFB + WLB superior to AFB alone for lung cancerous and precancerous lesions.

Clinical trial identification

It is a systematic review and meta-analysis, and all data come from published articles, therefore, it is non-essential to apply for protocol number of clinical trial.

Disclosure

All authors have declared no conflicts of interest.

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