Aetna considers lung imaging fluorescence endoscopy (LIFE) medically necessary to enhance the physician's ability to detect and biopsy abnormal bronchial tissue suspicious for pre-cancerous lesions, carcinomas in situ, and early bronchogenic carcinomas in any of the following groups:

1. Members with known or previously diagnosed lung cancer; or

2. Members with suspected lung cancer including:

   1. Members with a previously resected Stage I lung cancer, with no evidence of metastatic disease, who are at risk for secondary disease; or
   2. Members suspected of having lung cancer because of clinical symptoms such as positive sputum cytology, hemoptysis, unresolved pneumonia, persistent cough or positive X-ray.

In the treatment of lung cancer, the best outcome is achieved when the lesion is detected and localized in the pre-invasive stage. To date, conventional white-light bronchoscopy has been inadequate for the identification and localization of many early bronchogenic carcinomas, carcinomas in situ (CIS), and pre-cancerous dysplasias because these lesions may exhibit little visual difference from normal tissue when examined with white light.

Recently, the light imaging fluorescence endoscope (LIFE, Xillix Technology, Vancouver, BC) has been approved by the FDA and is now in routine use worldwide at 35 centers. The LIFE system has been developed based on the principle of autofluorescence, that is, abnormal tissues have the natural ability to fluoresce when exposed to a specific wavelength of light. The LIFE system utilizes a blue laser light transmitted through a flexible fiberoptic bronchoscope to elicit autofluorescence, which is then projected on to a video screen. Real-time differentiation of normal bronchial mucosa from dysplastic or carcinomatous mucosa guides the bronchoscopist's biopsies. Clinical studies have shown that autofluorescence bronchoscopy, when used in conjunction with standard white-light bronchoscopy, increases the detection rate of CIS and moderate to severe dysplasias by 50%, as compared to white-light bronchoscopy alone.

Note: LIFE is only indicated for use in conjunction with white-light bronchoscopy using an Olympus BF-20D flexible fiber optic bronchoscope and should not be used in combination with photosensitizing agents. LIFE is restricted by Federal law to be used only by physicians who have completed appropriate training in flexible fiber optic bronchoscopy and who have been trained in the use of the LIFE device

According to available literature, LIFE is considered medically inappropriate for any of the following groups:

1. Persons in whom white light bronchoscopic examination is contraindicated including:
   1. Persons with uncontrolled hypertension (systolic pressure greater than 200 mmHg, diastolic pressure greater than 120 mmHg);
   2. Persons with unstable angina;
   3. Persons with white blood count less than 2000 cells/microliter (ul) or greater than 20,000 cells/ul and/or platelet count less than 50,000/mm3;
   4. Persons with known bleeding disorder or members on anticoagulant therapy.

2. Persons in whom fluorescence examination is contraindicated including:
   1. Persons who have received fluorescent photosensitizing agents (hematoporphoryn derivatives) within 3 months prior to the procedure;
   2. Persons who are on, or have received chemo-preventive drugs (e.g., retinoic acid) within 3 months prior to the procedure;
   3. Persons who have received ionizing radiation treatment to the chest within 6 months prior to the procedure;
   4. Persons who have received cytotoxic chemotherapy agents systemically within 6 months prior to the procedure.