Multiple suspicious lesions detected by autofluorescence bronchoscopy predict malignant development in the bronchial mucosa in high risk patients

Pasic, Arifa; Vonk‐Noordegraaf, Anton; Risse, Elle K.J.; Postmus, Pieter E.; Sutedja, Tom G.

doi:10.1016/s0169-5002(03)00191-0

Cited by 47 publications

(32 citation statements)

References 28 publications

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“…Therefore, these investigational techniques, combined with minimally invasive intralesional treatment, can provide a costeffective early interventional management in the current screening area [10-20, 24, 26, 27, 71]. This has driven a paradigm shift towards early intervention, recognition of the individuals at the highest risk, biomolecular research, predictive algorithms for those at risk, and early interventional strategies, such as chemoprevention at the pre-neoplastic stage of early detected potentially malignant lesions [72][73][74][75][76][77][78]. The use of nonminimal invasive detection, staging and treatment methods for early parenchymal lesion is beyond the scope of the present article.…”

Section: Treatment With Curative Intentmentioning

confidence: 99%

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

Bolliger¹

2006

European Respiratory Journal

338

276

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Minimally invasive diagnostic and therapeutic approaches in medicine have been applied for a more selective and tailored approach to reduce patients' morbidity and mortality. The efficacy of interventional pulmonology for palliation of patients with central airways obstruction has been established and its curative potential for intralesional treatment of early cancer has raised great interest in current screening programmes. This is due to the fact that surgical resection and systemic nodal dissection as the gold standard is relatively morbid and risky, especially when dealing with individuals with limited functional reserves due to smoking-related comorbidities, such as chronic obstructive pulmonary disease. Furthermore, such comorbidities have been proven to harbour early stage lesions of several millimetres in size without involvement of nodal disease that may be amenable to local bronchoscopic treatment.Therefore, the success of minimally invasive strategies for palliation and treatment with curative intent strongly depends on the diligent identification of the various factors in lung cancer management, including full comprehension of the limits and potential of each particular technique. Maximal preservation of quality of life is a prerequisite in successfully dealing with individuals at risk of harbouring asymptomatic early lung cancer, to prevent aggressive surgical diagnostic and therapeutic strategies since overdiagnosis remains an issue that is heavily debated.In the palliative setting of alleviating central airway obstruction, laser resection, electrocautery, argon plasma coagulation and stenting are techniques that can provide immediate relief, in contrast to cryotherapy, brachytherapy and photodynamic therapy with delayed effects. With curative intent, intraluminal techniques that easily coagulate early stage cancer lesions will increase the implementation of interventional pulmonology for benign and relatively benign diseases, as well as early cancer lesions and its precursors at their earliest stage of disease.

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Section: Treatment With Curative Intentmentioning

confidence: 99%

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

Bolliger¹

2006

European Respiratory Journal

338

276

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“…Experimentation has revealed that bronchial and alveolar epithelial cells undergo multiple morphological and molecular changes before the overt expression of lung cancer. [3][4][5][6][7][8][9][10] However, only squamous dysplasia of bronchial epithelium and atypical adenomatous hyperplasia (AAH) have been extensively investigated [11][12][13][14][15][16][17] and listed as precursors of so-called central squamous cell carcinoma (SCC) or adenocarcinoma in the World Health Organization (WHO) histological classification of lung and pleural tumors. 18 The origin and development of central (ie bronchogenic) non-SCC and peripheral SCC are still poorly understood as yet.…”

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confidence: 99%

Histological types and significance of bronchial epithelial dysplasia

et al. 2006

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Pulmonary epithelium is known to undergo a preneoplastic process prior to the development of lung carcinoma. Squamous dysplasia and atypical adenomatous hyperplasia have been identified and classified as preinvasive lesions of squamous cell carcinoma and peripheral pulmonary adenocarcinoma, respectively. However, these commonly recognized preinvasive lesions do not completely explain the development of all histological types of lung carcinoma. By examining 114 resection lung specimens, we concluded that there are four histological patterns of bronchial epithelial dysplasia based on morphological features (basal cell dysplasia, columnar cell dysplasia, bronchial epithelial dysplasia with transitional differentiation, and squamous dysplasia). The histological patterns were further characterized by immunohistochemistry. Basal cell dysplasia was focally positive for cytokeratin (CK) 17 and 10/13; columnar cell dysplasia was generally positive for CK7, 8, and 18; bronchial epithelial dysplasia with transitional differentiation had a heterogeneous immunoprofile, while squamous dysplasia was positive for CK10/13 and focally positive for CK17. Various degrees of abnormal expression of p53 and Ki-67 were found in the different types of bronchial epithelial dysplasia. The cases were divided into three groups based on degree and extent of bronchial epithelial dysplasia. By Crosstabs McNemar test, the Mann-Whitney U-test (for two independent groups), the KruskalWallis one-way nonparametric ANOVA (for 42 independent groups) and Spearman correlation analysis, the degree and extent of bronchial epithelial dysplasia was shown to be positively correlated with the incidence of bronchogenic carcinoma and multifocal primary lung carcinoma (Po0.05). These findings indicated the following: (1) bronchial epithelium can develop various patterns of dysplasia with abnormal/ambiguous cell differentiation and abnormal expressions of p53 and Ki-67. Thus, these bronchial epithelial dysplastic lesions may represent a preneoplastic process. (2) The degree of bronchial epithelial dysplasia may significantly predispose individuals to bronchogenic carcinoma and multifocal primary lung carcinoma.

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“…Multiple preneoplastic lesions in the same individual detected by autofluorescence bronchoscopy (15), or persistence of preinvasive lesions on serial bronchoscopy and biopsy (by implication from the necessity to perform follow-up bronchoscopies in the current study (13) and the study by Ishizumi and colleagues [8]) are associated with an increased risk for development of invasive lung cancer. Genetic alterations in preinvasive lesions such as loss of heterozygosity of chromosome 3p (16), presence of chromosomal aneusomy identified by 4 fluorescence in situ hybridization probes (TP63, CEP3, CEP6, MYC) (17), SOX2 amplification (18), and copy number alterations at 3p26.3-p11.1, 3q26.2-29, and 6p25.3-24.3 (19) predicted development of lung cancer with high accuracy.…”

mentioning

confidence: 63%