OCCULT CARCINOMA OF THE LUNG

Preliminary report of the lung cancer detection program in New York

The early lung cancer detection program in New York is described, and preliminary prevalence rate data are reported. Cigarette-smoking men over the age of 45, who are considered at high risk, are encouraged to enroll in the program and, to date, 6,612 have done so. These men receive PA and lateral chest x-rays annually, while a randomly selected sub-population of about half also have sputum cytology every four months. A controlled study of sputum cytology as an adjunct to the chest x-ray is now in progress. There were 15 cases of late lung cancer (pathologic stages II and III) detected at the initial examination, and 11 early cases (pathologic stages O and I). In the population of 3,387 men who had x-rays alone there were three early lung cancers detected; in the population of 3,225 men who had both examinations four early cancers were detected by x-ray and four by cytology. In addition, three cases of larynx cancer were detected by cytology. The early lung cancers detected by x-ray were peripheral and most were bronchiolar or adenocarcinoma; the early cancers detected by cytology were central epidermoid carcinoma of major bronchi. No early carcinomas were detected by both techniques. These findings suggest that a combination of chest x-rays and sputum cytology can be more effective than either one alone in detecting early lung cancer.

Diagnostic and therapeutic challenges following the cytologic diagnosis of in situ carcinoma of the lung

Clinical challenges associated with the cytologic detection of eight cases of occult pulmonary carcinoma are presented. The pulmonary lesions were successfully localized and resected in three of six cases encountered since the availability of flexible fiberoptic bronchoscopy and selective bronchial brushing. Two of the resected neoplasms were unequivocally in situ, while preoperative radiotherapy precluded accurate pathologic determination of invasiveness in the third. The reported experience with unequivocal in situ bronchogenic carcinoma localized and treated surgically prior to invasion through the basement membrane now totals 17 cases (15 previously reported). Forty-four additional cases (43 previously reported) have been localized and resected following early invasion. From this group totaling 61 occult carcinomas, only two patients (3 percent) are known to have died of pulmonary carcinoma during a followup ranging from 2 to 20 years.