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

Abstract

Introduction Pre-invasive bronchial epithelial lesions are thought to be pre-malignant though it is not known what proportion will progress to invasive carcinoma. Although prevalent in heavy smokers, they are difficult to visualise by white light bronchoscopy. Fluorescence bronchoscopy enhances their detection and provides a unique opportunity to study their natural history but raises dilemmas regarding their management. We report the preliminary results of a longitudinal study using autofluorescence bronchoscopy.
Method Pre-invasive lesions identified in patients without evidence of invasive carcinoma elsewhere are followed by serial fluorescence bronchoscopy at intervals. Biopsies are stored for molecular genetic and immunohistochemical analyses. On proof or suspicion of malignancy, appropriate intervention is offered.
Results 15 patients are under surveillance (median age 67yrs range 50-76). Of 10 patients with high-grade lesions, 5 have progressed to squamous cell carcinoma (SCC) in 6-22 months. The remaining 5 patients with low-grade lesions have not progressed to a high-grade lesion in 3-48 months. Treatments for SCC were: surgery (1 patient), photodynamic therapy (PDT) (2), radical radiotherapy (1). 1 patient, treated with PDT after refusing surgery, developed metastases. The remainder are without recurrence at 6-18 months.
Conclusions Although this study is limited by relatively small patient numbers and short follow-up times, it shows a variable outcome in high-grade lesions. The results of molecular genetic and immunocytochemical analyses from these patients should provide insights into the mechanisms underlying progression to malignancy, when correlated with clinical outcome, and may identify markers of invasive disease.

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Citations should be made in the following way:
A. K. Banerjee, N. Foster, R. H. Pamela, G. Jeremy (Cambridge, London, United Kingdom). Surveillance bronchoscopy of pre-invasive lesions of the bronchus. Eur Respir J 2002; 20: Suppl. 38, 1178

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