Chest
Volume 117, Issue 6, June 2000, Pages 1572-1576
Journal home page for Chest

Clinical Investigations
CANCER
Outcome of Bronchial Carcinoma In Situ

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Introduction

The proportion of patients with carcinoma in situ in whom invasive cancer will develop is not known. It is important for clinical decision making to know the outcome of these lesions. The same applies for studies assessing the effectiveness of chemoprevention treatment or endobronchial therapy.

Methods

The records of patients with a bronchial carcinoma in situ who had undergone autofluorescence bronchoscopic examinations at regular intervals during a follow-up period for at least 6 months were reviewed. Data were examined for the outcome of carcinoma in situ, and for the detection, course, and bronchoscopic findings of neoplastic lesions at other bronchial sites.

Results

Progression to carcinoma occurred in five of nine patients (56%) with a carcinoma in situ. Eight neoplastic lesions were detected at other sites in four of the nine patients (44%). In earlier biopsy specimens of two sites that later showed a severe dysplasia and a carcinoma, only normal epithelium was found. Biopsies had been performed at these sites because they were assessed as suspicious during autofluorescence bronchoscopy.

Conclusion

The majority of sites showing a carcinoma in situ progressed to invasive carcinoma. A considerable portion of the patients had neoplastic lesions at other bronchial sites. The fluorescence pattern of the bronchial mucosa may reflect early changes that are not found at histopathologic examination, but which may progress to neoplastic growth.

Section snippets

Materials and Methods

The study population consisted of patients from the Department of Pulmonary Diseases of the University Hospital Vrije Universiteit in Amsterdam, a referral center for endobronchial therapy. The records of all patients who underwent autofluorescence bronchoscopy were reviewed. Indications for autofluorescence bronchoscopy in these patients were as follows: suspected lung cancer, staging of newly diagnosed lung cancer, or follow-up of lung or head and neck cancer. Patients were included in this

Patients

From all 140 patients who underwent autofluorescence bronchoscopy in the period from November 1995 to December 1998, 9 patients fulfilled the inclusion criteria. Patient demographics and bronchoscopy data are shown in Table 1 .

Eight patients were referred to us for assessment of a bronchial carcinoma in situ that was diagnosed by the referring pulmonologist. In five of these patients, the presence of carcinoma in situ was confirmed by pathologists from the Department of Pathology from the

Discussion

Progression to carcinoma was documented in five of nine patients (56%) with a carcinoma in situ. This number might have been greater if no endobronchial therapy had been performed. Two of the four patients without progression to carcinoma were treated with endobronchial therapy. Assuming that without this therapy a carcinoma would have developed, seven of the nine carcinomas (78%) in situ would have progressed to invasive carcinoma. This proportion is greater than the 11% of moderate dysplasias

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