Autofluorescence improves pretreatment mucosal assessment in head and neck cancer patients

Abstract

OBJECTIVE: Panendoscopy is used in selected patients with head and neck cancer to detect second primary disease. We hypothesized that adding autofluorescence to the bronchoscopy and laryngoscopy part of this procedure could add to the detection of clinically meaningful dysplasias and carcinomas in both the head and neck and bronchus, with resultant change in management. STUDY DESIGN: Prospective observational study on consecutive patients with head and neck cancer who had panendoscopy prior to surgery. SETTING: Teaching hospital, tertiary referral center. SUBJECTS AND METHODS: All patients had white-light inspection observed by ENT surgeons, followed by autofluorescence inspection of the head and neck tumor and surrounding area as well as the bronchus. Extra biopsies were taken from regions of abnormal fluorescence where there was no white-light abnormality. RESULTS: Sixty-six patients were studied; mean age 64.9 +/- 11 years. As a result of autofluorescence, 33 mucosal biopsies were taken from the head and neck and 37 from the bronchus. Histology included three carcinoma in situ lesions and four severe dysplasias. As a result of these autofluorescence biopsies, change of management occurred in four patients (6% of the total patients). Standard panendoscopy changed management in five patients. Therefore, standard panendoscopy led to change in management in only 55 percent of cases (CI 21%-86%, P = 0.02), with the rest detected by autofluorescence. CONCLUSION: Adding autofluorescence to panendoscopy in patients with head and neck cancer changed management in a clinically significant number of patients.