Source: Annual Congress 2002 - Thoracic oncology: clinical management
Disease area: Thoracic oncology

Abstract

Introduction. In early-stage central airway cancer, intraluminal brochoscopic treatments (IBT) like argon plasma coagulation (APC) enables us to redefine the surgical plane for resection. Auto-fluorescence bronchoscopy (AFB) may improve tumor margin delineation. In this case, pre-operative detection and treatment of proximally extending superficial spreading squamous cell cancer enabled resectability.
Case report. A 61-year old male with COPD was referred for radiographic occult lung cancer (ROLC). HRCT scan revealed thickening of the left upper lobe bronchial wall, extending proximally to the left main carina region. Bronchoscopy showed cobble stone mucosa of the left carina region extending distally to the left upper division bronchus. AFB using Laser Induced Fluorescence Endoscope (LIFE® Xillix, Richmond BC, Canada) enabled accurate biopsies from the proximal tumor border, showing severe dysplasia and brush cytology of a large cell cancer. The lesion was considered not occult, inappropriate for curative IBT and surgical resection would require a pneumonectomy. The proximal tumor extension of the left main carina and distal left main bronchus region was treated with APC (30 Watts) over a length of 1 cm. Surgical resection and cryosections demonstrated the proximal resection margin to be free of tumor, allowing left upper lobe lobectomy to be radical. Histologically the tumor was T1N0 and there has been no recurrence.
Conclusion. Pre-surgical detection of proximal tumor infiltration which require more extensive surgical resection should be carefully staged, and if possible treated with IBT to enable a (less extensive) surgical resection. This is a prudent strategy to preserve as much normal lung tissue as possible as many lung cancer patients also suffer from COPD and smoking related health problems.

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B. Schuurman, T. G. Sutedja (Amsterdam, The Netherlands). Combination of autofluorescence bronchoscopy and argon plasma coagulation enables less extensive resection of radiographic occult lung cancer. Eur Respir J 2002; 20: Suppl. 38, 1177

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