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Preinvasive Bronchial Lesions: Surveillance or Intervention?
Section snippets
Materials and Methods
Patients who are at high risk for lung cancer presenting to the University College London Hospitals Early Lung Cancer Detection Programme are evaluated using an autofluorescence bronchoscope (Karl Storz Gmbh; Tuttlingen, Germany). Those with preinvasive lesions but no clinical or radiologic evidence of invasive carcinoma are entered into the study. Patients with carcinoma who receive curative treatment but have preinvasive lesions at remote sites are also eligible for the study.
Results
Twenty-two patients (19 men) with a median age of 62 years (range, 49 to 75 years) were recruited into the study and have been observed for a mean duration of 22 months (range, 4 to 65 months). Twelve patients were current smokers, and 10 patients were former smokers (ie, they had stopped a mean duration of 9.9 years prior to study entry). The mean smoking consumption for the whole group of patients was 26.7 cigarettes per day (SD, 12.7 cigarettes per day) for an average duration of 46.2 years
Discussion
This study illustrates the unpredictable nature of preinvasive bronchial epithelial lesions. These lesions have the capacity to progress to invasive carcinoma, to regress toward normal, or to remain indolent for substantial periods of time, and their behavior appears to be independent of their histologic grade at the time of initial detection.
This study also illustrates the multifocal distribution of preinvasive lesions in keeping with the “field cancerization” effect of cigarette smoke.
ACKNOWLEDGMENT
The authors thank Karl Storz Gmbh for the loan of the D-light autofluorescence bronchoscope.
References (3)
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Localization of bronchial intraepithelial neoplastic lesions by fluorescence bronchoscopy
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(1998)
Cited by (11)
Risk of lung cancer in patients with preinvasive bronchial lesions followed by autofluorescence bronchoscopy and chest computed tomography
2011, Lung CancerCitation Excerpt :CIS lesions either persist in >60% cases with no regression or progress to invasive carcinoma in 20–60% of cases [11]. The entire bronchial epithelium is exposed to carcinogens from cigarette smoke, and malignancy can develop at any location within the exposed epithelium [12]. In addition, there is a discrepancy between the prevalence of preinvasive lesions and the incidence of lung cancer, which suggests that not all lesions inevitably develop into carcinoma [13,14].
Preinvasive lesions of the bronchus
2009, Journal of Thoracic OncologySequential screening for lung cancer in a high-risk group: Randomised controlled trial
2019, European Respiratory Journal
Support was provided by The Ellermann Foundation and University College London Hospitals Charitable Foundation; Karl Storz Gmbh, Tuttlingen, Germany, provided the loan of the fluorescence bronchoscope. However, no input into the study design, conduct, or results was made by the company, and the investigators remained completely independent.