Comparison of endoscopic features of early-stage squamous cell lung cancer and histological findings

Abstract

The introduction of sputum cytology screening in mass surveys has increased the detection of roentgenologically occult lung cancer (Matsuda et al, 1990). When severely atypical cells are detected in the sputum of subjects with normal roentgenographical findings, bronchoscopy should be performed, because most roentgenologically occult cancers, which are squamous cell carcinoma (SCC) histopathologically, are located in relatively large bronchi (Saito et al, 1992). Most roentgenologically occult cancers invade within the bronchial wall but are not accompanied by metastasis. In general, we classify such lesions as early-stage squamous cell carcinoma. However, it is difficult to evaluate the depth of intrabronchial invasion only from endoscopic features. Furthermore, the area of extent is small, and multicentric occurrence is frequently observed either synchronously, metachronously or both (Broghamer et al, 1985;Rosengart et al, 1991). Therefore, detailed observation based on extensive clinical experience in bronchoscopy is needed. However, the endoscopic criteria of early-stage central-type SCC remain to be clarified, especially concerning the relationship between endoscopic features and depth of intrabronchial invasion.Some reports indicate that endoscopic laser photodynamic therapy (PDT) (Okunaka et al, 1991) and brachytherapy (Saito et al, 1996) can yield curative results in early-stage central-type lung cancer. From the standpoint of both multicentric occurrence and high frequency in heavy smokers with poor pulmonary function, endoscopic laser therapy may be superior to surgical resection.However, in the case of endoscopic therapy there is a high possibility of residual lesions or local recurrence unless endoscopically accurate evaluation can be made of both the area of extent and depth of tumour invasion. Therefore, the establishment of endoscopic criteria of early-stage SCC is very important for the determination of appropriate therapeutic strategy.In this retrospective study in which seven institutes participated, the authors attempted to clarify the relationship between endoscopic features and both the extent and the depth of intrabronchial invasion based on histopathological evaluation of surgically resected specimens. PATIENTS AND METHODSSeventy patients with roentgenologically occult cancer, who were histopathologically diagnosed as early-stage central-type of squamous cell lung carcinoma, were resected between 1984 and 1993 at the seven institutes. We defined central-type lung cancer as tumour localization in the segmental or more proximal bronchi. Furthermore, we defined early-stage central-type squamous cell lung carcinoma as a lesion limited to within the bronchial wall without any metastasis. In these 70 cases we evaluated the relationship between endoscopic features and both the superficial extent and the depth of cancer invasion, using surgically resected specimens. Patient characteristicsEarly-stage central-type SCC were resected in 70 patients (67 men and three women). The age of the patients ran...

Therapeutic bronchoscopy with immediate effect: laser, electrocautery, argon plasma coagulation and stents

“…It is based on the recognition that minute early stage lesions within bronchoscopic visibility, according to strict bronchoscopic criteria (as proposed by IKEDA [67] in 1976), never have nodal disease. Meticulous histopathological studies from various Japanese centres and from the Mayo screening study confirmed the superficial nature of these lesions and the absence of the lymph nodes' metastasis [7,[68][69][70], while it has long been known that these lesions are only several millimetres thick. These data have increased the interest in applying PDT for treatment with curative intent and the move to early detection, localisation and application of methods for accurate staging prior to any treatment decision.…”

Early proximal lung cancer diagnosis and treatment

“…Surgical series and clinical trials with photodynamic therapy have been helpful in identifying lesions that are amenable to curative bronchoscopic therapy [7,8,11,85].…”

“…Combined imaging and diagnostic technologies should be applied in the assessment of these lesions and assist in the choice of optimal treatment. The use of autofluorescence bronchoscopy, radial transducer endobronchial ultrasound for assessing deeper tumour infiltration, highresolution thin-slice computed tomography and 18 fluorodeoxyglucose (FDG) positron emission tomography (PET), in addition to clinical assessment of patients and their comorbidities, may all influence management before choosing the optimal treatment strategy [85].…”

The role of endobronchial ultrasound in central early lung cancer

“…Konaka et al analyzed surgical specimens in patients with CELC and reported that the greatest tumor dimension strongly correlated with the depth of intrabronchial invasion of the tumor. 23 Over the last few years several studies have focused on the usefulness of EBUS in the assessment of tumor invasion (Fig. 2).…”

“…As lower frequencies give better penetration depth with less resolution, lineal EBUS are used basically for real-time transbronchial needle aspiration (TBNA) of hilar and mediastinal lesions. In contrast with linear transducers, probes with rotating transducers generate a complete circular image of the parabronchial structures and use higher frequencies (20)(21)(22)(23)(24)(25)(26)(27)(28)(29)(30). The standard frequency for a rotating transducer is 20 MHz which attains a resolution of 1 mm with a penetration depth of 4-5 cm.…”