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The specificity of fluorescence bronchoscopy has been found to be low, with up to one third of areas of abnormal fluorescence being found to be false positives.36 However, it has been suggested that up to 50% of the biopsies obtained from these areas carry molecular genetic lesions associated with malignancy, despite their normal histological appearance.37 Although it is well documented that histologically normal bronchial mucosa in heavy smokers may harbour molecular genetic damage associated with malignancy,38 a study from the MD Anderson hospital has suggested that fluorescence bronchoscopy is unlikely to have this degree of sensitivity.39 In this study, the results obtained with the LIFE device were compared with those obtained using white light bronchoscopy alone in a matched group of controls. The detection of metaplasia and dysplasia was not significantly increased in the LIFE group, while areas judged to be normal by the LIFE device yielded a similar number of metaplastic and dysplastic lesions as areas judged to be abnormal. However, the apparent discrepancy between the findings of the MD Anderson study and other studies has been attributed to the lower prevalence of severe dysplasia and absence of carcinoma in situ in the study group recruited into the MD Anderson study.40 It therefore seems likely that fluorescence bronchoscopy has sufficient sensitivity to detect moderate to severe dysplasia and carcinoma in situ but is less capable of reliably detecting milder degrees of dysplasia and metaplasia.