Prognostic implications of a positive bronchial resection margin

Abstract

Prognosis of peribronchial infiltration is similar to N2 disease. In situ carcinoma does not influence survival per se. Local control of disease is probably in part due to radiotherapy. However, the high prevalence of unrelated late deaths suggests an adverse impact of radiotherapy on survival.

Bronchial margins in lung cancer resection specimens: utility of frozen section and gross evaluation

“…20 Many but not all studies of positive margins of surgically treated lung cancers have shown adverse impact by residual disease. [1][2][3][4][5][6][7][8][9][10][11][12][13][14][15][16] Microscopic residual tumor at the bronchial resection margin has then been divided into different patterns. Cotton 1 first divided microscopic residual disease into mucosal tumor (spreading from a mucosal lesion), and extramucosal microscopic residual disease (tumor involving peribronchial soft tissues or tumor within lymphatics).…”

“…As described above, outcomes vary with site of positive margins, with submucosal, peribronchial and lymphatic space involvement at margins found to be worse than mucosal positive margins in most studies. 6,7,9,16,17,23 Several studies have found little benefit from postoperative radiation therapy. 3,5 Chemotherapy added to radiation therapy may add additional benefit in some series.…”

“…To this end, resection margins should be uninvolved with tumor. Many surgical series have demonstrated adverse patient outcome with either microscopic or macroscopic residual tumor at the bronchial resection margin, [1][2][3][4][5][6][7][8][9][10][11][12][13] and thus it is usually assumed that negative margins give the best chance for local control. However, poor outcomes with residual microscopic disease have not been reported by all authors.…”

“…18,19 Distinctions have also been made about different prognosis for positive margins of mucosal bronchial carcinoma (in situ and/or invasive tumor involving mucosa or submucosa), extramucosal peribronchial invasive carcinoma, and carcinoma within lymphatics at the bronchial margin. [4][5][6][7]9,11,17 In spite of the voluminous (and often conflicting) literature on this topic in the clinical cardiothoracic literature, little has been written in pathology journals about indications for frozen sections and gross evaluation of tumor distance to margins. This study was undertaken to look at the experience of bronchial margin evaluation at one institution, and to relate final margin status with gross distance from tumor, frozen section results and tumor type.…”

“Mas Spec Pen”, The New Future For Cancer Diagnosis: Mini Review

“…If positive marginal oncogenic cellswere found, the patients were subjected to additional surgery, hyperactive anxiety and discomfort [2][3][4][5]. There for it is becoming an indispensable need to analysis oncogenes in molecular labels by incorporating cancer specific biomarkers to improve cancer identification and screening.…”