Autofluorescence bronchoscopy for lung cancer screening: a time to reflect

The National Lung Cancer Screening Trial (NLCST), which showed a 20% relative risk reduction in lung cancer mortality with screening by low-dose computed tomography (CT) versus plain radiography, has resulted in growing organizational and institutional adoption of this practice across the United States and Canada (1,2). The rationale behind screening for this deadly malignancy with CT is analogous to mammographic screening for breast cancer in that it entails radiological detection of cancer that has already occurred but that is still at an early enough stage such that surgical cure is a possibility. The majority of parenchymal lesions thus detected are adenocarcinomas, which are known for their predilection for the lung periphery and represent the commonest lung cancer histology in North America (3).