Diagnostic value of white light bronchoscopy combined with autofluorescence bronchoscopy for early diagnosis of lung cancer: A systematic review

Objective: To evaluate the diagnostic value of white light bronchoscopy combined with autofluorescence bronchoscopy (AFB) for early diagnosis of lung cancer by meta-analysis. Methods: We searched PubMed, ISI Web of Knowledge, Chest, Cochrane and other databases (1990-2010) to collect studies which evaluated the diagnostic value of AFB for early diagnosis of lung cancer. The heterogeneity of included studies was tested by Meta-Disc1.4 software. The diagnostic value of WLB combines AFB for early diagnosis of lung cancer was evaluated by the pooled sensitivity, specificity, the likelihood ratio (LR) and summary receiver operating characteristic curve (SROC curve) statistical indicators. Results: Ten articles were collected and 2 157 cases were included in the studies. Totally 4 804 biopsies were obtained and 2 183 specimens were confirmed to be moderate or severe dysplasia, carcinoma in situ (CIS) and invasive cancer by pathology. Heterogeneity was found except for threshold effect. A meta-analysis was performed using the random effect model, and the value of the weighted sensitivity was 0.84 (95% CI: 0.81-0.86), the specificity was 0.61 (95% CI: 0.60-0.63), the positive likelihood ratio was 2.25 (95% CI: 2.12-2.39), negative likelihood ratio was 0.27 (95% CI: 0.23-0.32), and the SROC area under the curve (AUC) was 0.839 5. Subgroup analyses indicated that the SROC area under the curve (AUC) was 0.841 5 (by LIFE system) and (by D-light Storz system) 0.884 1. Conclusion: WLB combined with AFB has a certain specificity and high sensitivity for early diagnosis of lung cancer and could be regarded as one of the reference tests.