Background Endobronchial compromise with central airways obstruction (CAO) is a life threatening complication of lung cancer. Endobronchial treatments provide immediate symptom relief, while allowing other treatment modalities to begin. Yet the prevalence of this condition is poorly defined. We set to identify the prevalence of CAO to inform the development of an interventional service.
Method Between 11/2014–11/2015, we reviewed the index computer tomography (CT) scans of all patients diagnosed with a thoracic malignancy. Data collected included staging and the presence of endobronchial involvement. In patients with reported endobronchial involvement, images were reviewed for suitability of airway treatment.
Results Over the study period 434 patients were diagnosed with a thoracic malignancy. In 51 non-primary bronchogenic malignancies were identified, including 41 mesotheliomas. Of the remaining 383 patients with lung cancer, 359 underwent an index CT scan. Staging by CT was reported in 291 (81.0%) patients. Of the 359 patients with CT imaging available, endobronchial disease was present in 111 (30.9% (95% confidence intervals (CI) 26.1–35.7%), with 29 (8.0%; 95% CI: 5.2–10.8%) patients having CAO. Of these, the commonest site was the bronchus intermedius (62.1%). The median degree of obstruction was 71.4% (interquartile range 50–100). Extrinsic compression was dominant in 8 (27.6%) patients. By cell type, squamous cell carcinoma, NSCLC-NOS, small cell lung carcinoma, and adenocarcinoma accounted for 9 (31.0%), 5 (17.2%), 4 (13.8%), and 4 (13.8%) cases respectively. In 9 (31.0%) no histology was available. Of those patients with CAO, 26 (89.7%) could be considered for airway treatments, however only 3 (12%) had a therapeutic procedure performed. Of 18 patients with follow up imaging, 8 (44%) developed obstructive complications.
Conclusions CAO affects nearly 1 in 10 lung cancer patients at the time of diagnosis and services should be developed to evaluate and offer timely intervention. Further longitudinal data will help predict the risk of developing central airways obstruction.