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Surveillance for the detection of early lung cancer in patients with bronchial dysplasia
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  1. Philip Jeremy George1,
  2. Anindo K Banerjee1,
  3. Catherine A Read2,
  4. Caoihme O’Sullivan3,
  5. Mary Falzon4,
  6. Francesco Pezzella5,
  7. Andrew G Nicholson6,
  8. Penny Shaw7,
  9. Geoff Laurent1,
  10. Pamela H Rabbitts8
  1. 1Centre for Respiratory Research, Department of Medicine, University College London, London, UK
  2. 2Department of Thoracic Medicine, University College London Hospitals, London, UK
  3. 3University College London Hospitals, London, UK
  4. 4Department of Histopathology, University College London Hospitals, London, UK
  5. 5Nuffield Department of Clinical Laboratory Science, John Radcliffe Hospital, Oxford, UK
  6. 6Department of Histopathology, Royal Brompton Hospital, London, UK
  7. 7Department of Radiology, University College London Hospitals, London, UK
  8. 8Leeds Institute for Molecular Medicine, University of Leeds, St James’s University Hospital, Leeds, UK
  1. Correspondence to:
    Dr P J George
    Department of Thoracic Medicine, University College London Hospitals, Grafton Way, London WC1E 6AU, UK; jeremy.george{at}uclh.org

Abstract

Background: The natural history of bronchial preinvasive lesions and the risk of developing lung cancer in patients with these lesions are not clear. Previous studies have treated severe dysplasia and carcinoma in situ (CIS) on the assumption that most will progress to invasive carcinoma.

Aims: To define the natural history of preinvasive lesions and assess lung cancer risk in patients with these lesions.

Hypothesis: Most preinvasive lesions will not progress to invasive carcinoma but patients with these lesions will be at high risk.

Methods: A cohort of patients with preinvasive lesions underwent fluorescence bronchoscopy every 4–12 months and computed tomography of the chest annually. The main end point was the development of invasive carcinoma.

Results: 22 patients with 53 lesions were followed up for 12–85 months. 11 cancers were diagnosed in 9 patients. Of the 36 high-grade lesions (severe dysplasia and CIS), 6 progressed to invasive cancers. 5 separate cancers developed at remote sites in patients with high-grade lesions. All cancers were N0M0 and curative treatment was given to 8 of the 9 patients. The cumulative risk of developing lung cancer in a patient with a high-grade lesion was 33% and 54% at 1 and 2 years, respectively. Of the 17 low-grade lesions, none progressed to invasive carcinoma.

Conclusions: Although the risk of malignant progression of individual preinvasive lesions is relatively small, patients with high-grade lesions are at high risk of lung cancer. Surveillance facilitated early detection and treatment with curative intent in most patients.

  • CIS, carcinoma in situ
  • PET, positron emission tomography
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Footnotes

  • Published Online First 23 August 2006

  • Funding: The work was supported by the University College London Hospitals Charitable Foundation. Karl Storz GmbH, Germany, supported the project with the unconditional loan and maintenance of the fluorescence bronchoscope. AKB was supported by a grant from the Ellermann Foundation. PHR was supported by MRC Programme grant number G9703123. FP was supported by Cancer Research UK.

  • Competing interests: None.

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