Local Recurrence at the Bronchial Stump Site of Post-Operative Non-Small Cell Lung Cancer Patients: Comparison of CT Findings and Bronchoscopy

Abstract

Purpose:To compare computed tomography (CT) images and bronchoscopic findings of local tumor recurrence at the bronchial stump site in post-operative non-small cell lung cancer (NSCLC) patients. Materials and Methods: A retrospective study was conducted to review the CT images of 9 lung cancer cases that recurred at the bronchial stump site on 576 resected primary non-small cell lung cancers over a 9-year period. The CT images of the bronchial stump site recurrence were classified as: bronchial wall thickening, nodular or endobronchial polypoid lesion, multiplicity, and enhancement patterns. We classified the bronchoscopic findings based on the revised classification by the Japan Lung Cancer Society. Results: The histologic types of the 9 cases of lung cancer that recurred, included 7 squamous cell carcinomas, 1 adenocarcinoma, and 1 adenoid cystic carcinoma. The CT findings included bronchial wall thickening with nodules (n = 6) and endobronchial polypoid nodules (n = 3) with heterogeneous enhancement. The CT findings were further classified as nodular infiltrating type (n = 5), polypoid type (n = 3) and superficial infiltrating type (n = 1) on bronchoscopy. Conclusion: Both a bronchoscopy and CT can be used as a complementary or alternative tool in evaluating bronchial stump site recurrences.

Bronchial Stump Recurrence after Complete Resection of Lung Cancer: Effect of the Distance between the Tumor and Bronchial Resection Margin

“…The exclusion of these cases, and also, the exclusion of patients with mediastinal lymph node metastasis could be the reasons for our lower BSR rate. However, as has been shown in previous studies, 5,10,11,13 our study confirmed that, although a thorough microscopic evaluation showed that the resection margin was clear after lung cancer surgery, BSR can develop. Regarding BSR after complete resection, it is possible that the bronchial margin showed no evidence of disease after conventional histopathologic examination can have overlooked cancer cells; microscopic evaluation may not be sufficient to confirm the absence of residual cancer cells.…”

“…In those articles, it was reported that 2.1 to 3.4% of the patients develop BSR after surgical treatment. 5,[10][11][12] In some studies, only patients with complete resection were included 10,11 ; however, most of the studies also had patients with microscopically incomplete cancer resections, and all the studies had patients with mediastinal lymph node metastasis. No study has compared patients with and without BSR.…”

“…In most of the studies, the histopathological type of tumor in patients with BSR was reported as squamous cell carcinoma. 5,10,11,21 However, no study has compared the histopathological tumor type between patients with or without BSR development. In our study, we also found squamous cell carcinoma in seven of the eight patients who developed BSR; however, due to the high rate of squamous cell carcinoma in the entire series, this is not an unexpected result.…”