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When illuminated with a certain wavelength, lung tissue emits a weak fluorescence. The fluorescence from normal tissue is different from that from diseased tissue. This technique can thus be used for early diagnosis of precancerous lesions. Technical manipulations are required to amplify the fluorescence signal. Numerous studies have used the LIFE (Lung Imaging Fluorescent Endoscope) to study lung diseases. This system of detection uses a laser helium-cadmium excitation source; the principal photosensitizing agents are hematoporphyrin derivatives. The cost, bulkiness and secondary effects have limited diffusion of this type of photodynamic diagnostic system. We have used 2 systems (SAFE 1000 Pentax and D-LIGHT Storz) successively in a prospective study to analyze autofluorescence of lung tissue without laser illumination or photosensitization. Fifty-four patients were selected for their risk factors. We were able to detect one case of severe dysplasia but did not identify any case of carcinoma in situ. Among 18 cases, 16 were evident with white light. Two were detected with autofluorescence used to orient biopsies while white light had only revealed a common inflammatory aspect. Thirty-nine low-grade lesions (metaplasia, dysplasia) were found. The systems are easy to use. Lower cost would allow more widespread use of these systems currently reserved for risk populations. These techniques broaden the scope of interventional endoscopy.

In order to use the selectivity of fluorescence emission for biomedical purposes, a microspectrofluorimeter has been built around an inverted microscope. The excitation is supplied by a 450 W Xenon lamp coupled with a monochromator allowing excitation from 230 to 600 nm. The fluorescence is analysed by a Grism (association prism-grating) and the spectrum focused on the 500 channels of the target of an Optical Multichannel Analyser. Related to good resolution and dispersion (0.44 nm/channel), improvement of signal to noise ratio (dark current suppression, and accumulation of spectra), this microspectrofluorimeter with high sensitivity is well adapted to the study of biological mechanism in single living cells (macrophages, monocytes, lumphocytes).