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Solitary and multiple resected adenocarcinomas after CT screening for lung cancer: histopathologic features and their prognostic implications. Lung Cancer 2008; 64:148-54. [PMID: 18951650 DOI: 10.1016/j.lungcan.2008.08.009] [Citation(s) in RCA: 160] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2008] [Revised: 07/28/2008] [Accepted: 08/02/2008] [Indexed: 10/21/2022]
Abstract
PURPOSE To study the histopathologic features of CT screen-detected Stage IA adenocarcinomas to determine whether survival differed by the proportion of bronchioloalveolar component (BAC) or by the presence of multiple lesions in node-negative patients. METHODS Five pathologists with expertise in pulmonary pathology examined 279 resected cases of adenocarcinomas, 30 mm or less in length diagnosed by CT screening for lung cancer. The panel determined the consensus diagnosis for each case, identified additional cancers, and classified each case as solitary or non-solitary. The presence and proportion of BAC was also documented. RESULTS Of the cases of adenocarcinoma, 20 (7%) were BAC subtype, 246 (88%) mixed subtype and 13 (5%) adenocarcinoma-OTHER. BAC cases manifested as non-solid and part solid nodules, mixed as solid and part-solid, and other as solid only. Kaplan-Meier 10-year survival rates were 100% for BAC and adeno-MIXED with 90-99% BAC cases, 95% for mixed with 1-90% BAC, 90% for those without a BAC component, and 75% for other cases. Fifty (18%) cases were non-solitary carcinomas and 44 of these were node negative; the non-solitary node-negative cases had the same excellent prognosis as solitary node-negative cases. CONCLUSIONS The proportion of BAC component was a positive prognostic factor and correlated with CT consistency. Contrary to staging predictions, cases of non-solitary node-negative adenocarcinoma had the same excellent prognosis as solitary node-negative cases, suggesting that most of the small, node-negative multiple carcinomas probably represent multiple primaries rather than intrapulmonary metastasis.
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Sakurai H, Asamura H, Watanabe SI, Suzuki K, Tsuchiya R. Clinicopathologic features of peripheral squamous cell carcinoma of the lung. Ann Thorac Surg 2004; 78:222-7. [PMID: 15223433 DOI: 10.1016/j.athoracsur.2004.01.029] [Citation(s) in RCA: 53] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 01/22/2004] [Indexed: 11/16/2022]
Abstract
BACKGROUND The clinicopathologic features are still unknown in peripheral squamous cell carcinoma of the lung, unlike centrally located carcinomas. In this retrospective study, we investigated the clinicopathologic characteristics of patients with peripheral squamous cell carcinomas. METHODS Of 1,381 primary lung carcinomas surgically resected at the National Cancer Center Hospital, Tokyo, from 1995 through 2001, 70 (5.1%) peripheral squamous cell carcinomas of 3.0 cm or less in diameter were studied retrospectively in terms of clinicopathologic characteristics such as age, sex, past history, smoking, tumor size, mode of operation, extent of lymph node dissection, pathologic lymph node status, mode of recurrence, and cause of death. RESULTS These patients ranged in age from 49 to 82 years, with a mean age of 69.2 years. Thirty-nine patients (56%) were at increased risk preoperatively. The incidence of lymph node metastasis was 25%, and larger tumors tended to be associated with a higher prevalence, although this difference was not significant (p = 0.12). None of the patients with N2 disease had skipping metastasis. Recurrence was observed in 13 patients (19%). There was no significant correlation between recurrence and the extent of lymphadenectomy or the mode of operation. The 5-year overall and disease-specific survival rates were 73.4% and 85.9%, respectively. The cause of death was recurrence in 53% and other disease in 47%. CONCLUSIONS We propose that mediastinal hilar lymphadenectomy should be routinely conducted as a curative operation for low-risk patients with small peripheral squamous cell carcinoma. We further propose that for patients who may have difficulty tolerating this procedure, pathologic examination of intraoperative frozen sections from the hilar node could be useful for planning a surgical strategy.
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Affiliation(s)
- Hiroyuki Sakurai
- Division of Thoracic Surgery, National Cancer Center Hospital, Tokyo, Japan.
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Han NJ, Song KS, Lee KH, Seo JB, Lee JS, Lim TH, Kang GH. Superficial endobronchial lung cancer: radiologic-pathologic correlation. Korean J Radiol 2002; 3:229-34. [PMID: 12514339 PMCID: PMC2713844 DOI: 10.3348/kjr.2002.3.4.229] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
OBJECTIVE To analyze the plain chest radiographic and CT findings of superficial endobronchial lung cancer and to correlate these with the findings of histopathology. MATERIALS AND METHODS This study involved 19 consecutive patients with pathologically proven lung cancer confined to the bronchial wall. Chest radiographs and CT scans were reviewed for the presence of parenchymal abnormalities, endobronchial nodules, bronchial obstruction, and bronchial wall thickening and stenosis. The CT and histopathologic findings were compared. RESULTS Sixteen of the 19 patients had abnormal chest radiographic findings, while in 15 (79%), CT revealed bronchial abnormalities: an endobronchial nodule in seven, bronchial obstruction in five, and bronchial wall thickening and stenosis in three. Histopathologically, the lesions appeared as endobronchial nodules in 11 patients, irregular thickening of the bronchial wall in six, elevated mucosa in one, and carcinoma in situ in one. CONCLUSION CT helps detect superficial endobronchial lung cancer in 79% of these patients, though there is some disagreement between the CT findings and the pathologic pattern of bronchial lesions. Although nonspecific, findings of bronchial obstruction or bronchial wall thickening and stenosis should not be overlooked, and if clinically necessary, bronchoscopy should be performed.
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Affiliation(s)
- Nae Jin Han
- Department of Radiology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Koun-Sik Song
- Department of Radiology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Kyung Hee Lee
- Department of Radiology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Joon Beom Seo
- Department of Radiology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Jin Seong Lee
- Department of Radiology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Tae-Hwan Lim
- Department of Radiology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Gil Hyun Kang
- Department of Diagnostic Pathology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
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Deygas N, Froudarakis M, Ozenne G, Vergnon JM. Cryotherapy in early superficial bronchogenic carcinoma. Chest 2001; 120:26-31. [PMID: 11451811 DOI: 10.1378/chest.120.1.26] [Citation(s) in RCA: 94] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/01/2022] Open
Abstract
BACKGROUND Treatment of early superficial bronchogenic carcinoma (ESBC) is under debate, and no consensus has been achieved. Different therapeutic methods have been proposed, including surgical resection and endoscopic methods. STUDY OBJECTIVE To assess the efficacy of cryotherapy in patients with ESBC. PATIENTS AND METHODS Patients included in the study had histologically proven ESBC after fiberoptic bronchoscopy. Cryotherapy was performed through a rigid bronchoscope. Efficacy was assessed by endoscopy with multiple biopsies 1 month after treatment and during the follow-up period. Parameters studied were response to treatment, adverse effects, and survival. RESULTS We included 35 patients (34 men and 1 woman). The mean age was 61 +/- 9 years. Multiple locations of ESBC were observed in seven patients (20%). Complete response rate at both 1 month and 1 year was 91% (32 patients). No severe adverse effects were noted. Local recurrence was observed within 4 years in 10 patients (28%). A follow-up period of at least 4 years was available in 22 patients; of them, 11 patients (50%) were long-term survivors. CONCLUSION Our results suggest that cryotherapy is an effective method of treatment in patients with ESBC. Due to its relative tolerance compared to surgery, cryotherapy could be proposed as a first-line therapy in this population with high carcinogenic risk.
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Affiliation(s)
- N Deygas
- Service de pneumologie et d'oncologie thoracique, Hôpital Nord, Saint-Etienne, France
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6
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Abstract
BACKGROUND Disease-free survival after surgical resection of lung carcinoma in situ has been reported as over 90%. After resection of stage IA non-small cell lung cancer, survival at 5 years is approximately 60% to 70%. If endoscopic or bronchoscopic treatments of early-stage lung cancer can provide similar disease-free survival with less perioperative mortality, morbidity, and cost, then they may be alternative front-line therapies. METHODS The authors review early-stage lung cancer detection by fluorescence bronchoscopy and the potential treatment of this disease by endoscopic techniques (photodynamic therapy, brachytherapy, Nd:YAG laser, electrocautery, and cryotherapy). RESULTS Several reports have noted improved outcomes using endoscopic therapies for early-stage lung cancer, but insufficient data preclude firm conclusions regarding the role of fluorescence bronchoscopy, endobronchial brachytherapy, or electrocautery in early-stage lung cancer. Other than resection, photodynamic therapy may represent the best approach at this time. The principal indication for laser bronchoscopy is palliation of central airway obstruction. CONCLUSIONS The identification of early-stage lung cancer provides no advantage if we have little to offer the patient short of traditional therapy. The value of newer treatment techniques and methods requires verification.
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Affiliation(s)
- F D Sheski
- Division of Pulmonary, Allergy, Critical Care, and Occupational Medicine, Indiana University School of Medicine, Indianapolis 46202, USA
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7
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Fontanini G, Vignati S, Bigini D, Merlo GR, Ribecchini A, Angeletti CA, Basolo F, Pingitore R, Bevilacqua G. Human non-small cell lung cancer: p53 protein accumulation is an early event and persists during metastatic progression. J Pathol 1994; 174:23-31. [PMID: 7965400 DOI: 10.1002/path.1711740105] [Citation(s) in RCA: 41] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/28/2023]
Abstract
Mutations in the p53 tumour suppressor gene, with consequent accumulation of the p53 protein, are frequently observed in non-small cell lung cancer (NSCLC). Little is known, however, about the timing of their appearance or their maintenance through cancer progression and metastatic spread. We have examined the normal epithelium and a panel of bronchial lesions, including dysplastic, neoplastic, and metastatic lesions, for p53 immunoreactivity and for expression of proliferating cell nuclear antigen (PCNA). No p53 immunoreactivity was found in normal and hyperplastic epithelium, nor in squamous metaplastic lesions. Twenty out of 30 invasive tumours and 13 out of 17 in situ carcinomas adjacent to an invasive tumour showed p53 immunoreactivity. There was a strict correlation between the level of p53 expression in the non-invasive and the invasive components of the tumours. Five out of eight pairs of primary tumours and matching metastases expressed p53, at identical levels in both compartments. These data indicate that p53 overexpression can occur in the earliest recognized phase of NSCLC and that the alteration is maintained during progression from in situ to invasive carcinoma and metastatic spread. PCNA expression increased from early to advanced phases of NSCLC. High PCNA immunoreactivity was observed in tumours expressing high p53 levels. A significant association was observed for PCNA expression between preinvasive and invasive lesions.
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Affiliation(s)
- G Fontanini
- Institute of Pathology, University of Pisa, Italy
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Relation between bronchoscopic findings and tumor size of roentgenographically occult bronchogenic squamous cell carcinoma. J Thorac Cardiovasc Surg 1993. [DOI: 10.1016/s0022-5223(19)33984-4] [Citation(s) in RCA: 35] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
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9
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Melamed MR, Flehinger BJ. Early lung cancer as a potential target for chemoprevention. JOURNAL OF CELLULAR BIOCHEMISTRY. SUPPLEMENT 1993; 17F:57-65. [PMID: 8412209 DOI: 10.1002/jcb.240531009] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/30/2023]
Abstract
Carcinoma of the lung is the most common cause of death from cancer in the United States. In considering lung cancer for possible chemoprevention trials, we have analyzed the data collected by the collaborative NCI program on early lung cancer. The data indicate that at least 12 years of study of 80,000 people at risk for lung cancer (adult male cigarette smokers) would be required to establish a 25% reduction in squamous carcinoma of the lung. No intermediate markers of developing lung cancer are presently available to shorten the observation period. It is concluded that a study of the magnitude required is not feasible at the present time.
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Affiliation(s)
- M R Melamed
- Dept. of Pathology, New York Medical College, Valhalla 10595
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Gerasin VA, Levashov YN, Shafirovscy BB, Berezin YD, Jurba VM, Palamarchuk GF. Bronchoscopic laser photocoagulation of superficial cancer of the bronchi. Chest 1990; 98:235-6. [PMID: 2361395 DOI: 10.1378/chest.98.1.235] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022] Open
Abstract
Multifocal squamous cell carcinoma in the bronchus of the anterior segment of the right lung and in the subsegmental bronchus of the posterior subsegment of the left upper lobe was diagnosed in a 61-year-old man. The right-sided upper lobectomy followed by Nd:YAG laser photocoagulation of the superficial cancer in the left side resulted in total eradication of the tumor. Subsequent follow-up examinations for three years have revealed no relapse of tumor growth.
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Affiliation(s)
- V A Gerasin
- Division of Bronchology, All-Union Research Institute of Pulmonology, Leningrad, USSR
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Suzuki M, Takahashi T, Ouchi K, Matsuno S. The development and extension of hepatohilar bile duct carcinoma. A three-dimensional tumor mapping in the intrahepatic biliary tree visualized with the aid of a graphics computer system. Cancer 1989; 64:658-66. [PMID: 2545324 DOI: 10.1002/1097-0142(19890801)64:3<658::aid-cncr2820640316>3.0.co;2-6] [Citation(s) in RCA: 70] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
Abstract
Computer-assisted three-dimensional (3D) reconstruction of the biliary tree including extrahepatic and intrahepatic parts was performed from surgical or autopsy materials from 12 patients with hepatohilar bile duct carcinoma in an effort to visualize three-dimensionally the distribution of carcinoma and dysplasia. In each case, material including a hepatic lobe was reduced to serial slices 1 mm thick using a ham slicer, then the tumors, ducts with carcinoma in situ, and those with dysplasia were submitted to reconstruction. In a 3D map of biliary tree reproduced on a display, a dysplastic zone was shown in most cases surrounding a focus of carcinoma, justifying the assumption of a dysplasia-carcinoma sequence. The carcinoma itself proved to form multiple foci along bile ducts in as many as 42% of the patients, in some of whom the foci were independent without any intervening dysplasia. These results suggest that as extensive a surgical measure as possible should be taken in designing a strategy against this tumor.
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Affiliation(s)
- M Suzuki
- Department of Pathology, Tohoku University, Sendai, Japan
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12
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Rodriguez Casquero C, De las Heras P, Leon C, Estrada G, Gomez G, Puzo C. Carcinomas bronquiales in situ e invasores precoces. Estudio de 11 casos. Arch Bronconeumol 1987. [DOI: 10.1016/s0300-2896(15)31992-x] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
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Abstract
From 1978-1980, 20 patients with radiographically occult squamous cell carcinoma of the lung were admitted to Toronto General Hospital. Among them, five had in situ carcinoma, three had microinvasive carcinoma, and 12 early invasive. All cases were first diagnosed by cytologic examinations of sputum, localized by bronchoscopy, and had been verified histologically. It appears that a cytologic diagnosis of in situ squamous cell carcinoma of the lung could not be established on the basis of a single abnormal squamous cell or an occasional group of abnormal cells, but could be reached by putting together all the cytologic findings observed in the preparations. The criteria for the cytologic diagnosis are elucidated. Cytomorphologically there was no difference between microinvasive and advanced invasive carcinoma. However, in a patient with known localized in situ carcinoma and previous persistent cytologic findings of the same from that particular site, the finding of frankly malignant cells from the same site in the follow-up bronchoscopic examination was almost definitely an indication of microinvasive carcinoma, which usually showed evidence of both in situ and invasive carcinoma in the bronchial brushing specimens. None of the three microinvasive carcinoma cases had positive lymph nodes, but four of the 12 patients with early invasive carcinoma had metastases to the nodes at the time of surgery. Hence, the best time to effectively treat the invasive squamous cell carcinoma of the lung is at the microinvasive stage when the disease is considered curable.
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15
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Balchum OJ, Doiron DR, Profio AE, Huth GC. Fluorescence bronchoscopy for localizing early bronchial cancer and carcinoma in situ. Recent Results Cancer Res 1982; 82:97-120. [PMID: 7111846 DOI: 10.1007/978-3-642-81768-7_10] [Citation(s) in RCA: 21] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/23/2023]
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16
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Abstract
In 1974, we reported 26 patients with roentgenographically occult lung carcinomas. In 13 (50%) of them, the tumor was localized and treated by resection while the disease was still early (Stage I). These patients have done well, and the median survival has reached 8 years. We have added 21 patients to the series since our last report. Localization was by fiberoptic bronchoscopy in all 21. Fourteen of these patients had Stage I disease and were treated by resection. Of a total of 27 patients with early disease treated by resection, none has had recurrence after follow-up extending from 2 months to 20 years. However, in 21 of the entire 47 patients (45%) a second carcinoma developed, 15 (71%) of which were second lung carcinomas.
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17
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Albores-Saavedra J, Alcántra-Vazquez A, Cruz-Ortiz H, Herrera-Goepfert R. The precursor lesions of invasive gallbladder carcinoma. Hyperplasia, atypical hyperplasia and carcinoma in situ. Cancer 1980; 45:919-27. [PMID: 7260842 DOI: 10.1002/1097-0142(19800301)45:5<919::aid-cncr2820450514>3.0.co;2-4] [Citation(s) in RCA: 110] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/24/2023]
Abstract
In 200 consecutive cholecystectomy specimens excised for cholelithiasis or cholecystitis, 83% exhibited epithelial hyperplasia, 13.5%, atypical hyperplasia and 3.5%, carcinoma in situ. Carcinoma in situ was also observed in the mucosa adjacent to invasive carcinomas in 79% of 39 evaluable surgical cases and in 52.9% of 17 autopsy cases. Our findings suggest that a small number of hyperplasias of the gallbladder evolve toward atypical hyperplasia and that this progresses to in situ carcinoma which finally becomes invasive carcinoma. A simple cytologic technique is recommended for the diagnosis of atypical hyperplasia and carcinoma in situ in excised gallbladders. Preoperative identification of these two lesions in high-risk patients as well as comments on 156 invasive carcinomas are presented.
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Moreno A, De las Heras P, Bordes R, Bonnin J. Carcinoma broncogeno incipiente con crecimiento polipoide intrabronquial. Arch Bronconeumol 1979. [DOI: 10.1016/s0300-2896(15)32582-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
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19
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A method for experimental induction of bronchogenic carcinoma in subcutaneously implanted bronchial autograft in dogs. J Thorac Cardiovasc Surg 1978. [DOI: 10.1016/s0022-5223(19)41273-7] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
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Falkenbach KH. Diagnostic Radiology in Bronchogenic Carcinoma Today. Chest 1977. [DOI: 10.1378/chest.71.5.625] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/01/2022] Open
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Abstract
The results of trials testing combined surgery and chemotherapy in lung cancer are reviewed. Fifteen adjuvant trials using various chemotherapeutic agents were analyzed to determine reasons for their lack of success. Current trials with adjuvant therapy in lung cancer are briefly outlined. In addition, analysis of the activity of chemotherapeutic agents in advanced lung cancer and its implications in the design of future adjuvant studies are detailed.
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Melamed M, Flehinger B, Miller D, Osborne R, Zaman M, McGinnis C, Martini N. Preliminary report of the lung cancer detection program in New York. Cancer 1977; 39:369-82. [PMID: 837325 DOI: 10.1002/1097-0142(197702)39:2<369::aid-cncr2820390202>3.0.co;2-i] [Citation(s) in RCA: 38] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
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.
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Ray JF, Lawton BR, Myers WO, Sautter RD. Lung cancer size and prognosis. Ann Thorac Surg 1977; 23:194-5. [PMID: 836107 DOI: 10.1016/s0003-4975(10)64098-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
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Ray JF, Lawton BR, Magnin GE, Dovenbarger WV, Smullen WA, Reyes CN, Myers WO, Wenzel FJ, Sautter RD. The coin lesion story: update 1976. Twenty years' experience with thoracotomy for 179 suspected malignant coin lesions. Chest 1976; 70:332-6. [PMID: 954458 DOI: 10.1378/chest.70.3.332] [Citation(s) in RCA: 60] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022] Open
Abstract
We reviewed 179 patients who had undergone thoracotomy and resection of a suspected malignant coin lesion of the lung over the past 20 years to see if a policy of early thoracotomy was therapeutically valid. The average diameter of all lesions was 1.6 cm; the average diameter of 27 malignant lesions (15 percent) was 1.8 cm. Follow-up of the 27 patients with malignant neoplasms was 100 percent. The present survival rate of the 19 patients with primary lung cancer is 89 percent (17/19). Of 12 cases of primary lung cancer followed for five years, ten (83 percent) survived. The five-year survival of the eight patients with metastatic lesions was 25 percent (2/8). There were no postoperative deaths and few serious postoperative complications (four patients or 2 percent). Very small primary lung cancers detected and treated early do have the same poor prognosis as larger primary cancers.
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Carter D, Marsh BR, Baker R, Erozan YS, Frost JK. Relationships of morphology to clinical presentation in ten cases of early squamous cell carcinoma of the lung. Cancer 1976; 37:1389-96. [PMID: 1260659 DOI: 10.1002/1097-0142(197603)37:3<1389::aid-cncr2820370320>3.0.co;2-p] [Citation(s) in RCA: 17] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
Abstract
The morphologic changes in 10 patients who were found to have squamous cell carcinoma of the lung before they became evident on chest x ray are discussed. It is suggested that these cases have a long preclinical course as invasive carcinomas that ranges from a microscopic focus of microinvasion (possibly originating from in situ carcinoma in submucosal gland epithelium) to a large concentric carcinoma which may have metastasized to regional lymph nodes. Although the duration of the in situ phase of squamous cell carcinoma of the bronchus in not known, it was evident that the expanse of in situ carcinoma frequently far exceeded that of the invasive carcinoma, and usually extended proximal to the invasive lesion. It is important that the extent of the in situ lesion is determined preoperatively. Finally, multifocal in situ (or invasive) carcinoma was found in at least two of the cases, either synchronously or metachronously.
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26
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Fontana RS, Sanderson DR, Woolner LB, Miller WE, Bernatz PE, Payne WS, Taylor WF. The Mayo Lung Project for early detection and localization of bronchogenic carcinoma: a status report. Chest 1975; 67:511-22. [PMID: 1126186 DOI: 10.1378/chest.67.5.511] [Citation(s) in RCA: 90] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022] Open
Abstract
The Mayo Lung Project (MLP) is a screening program designed to detect bronchogenic carcinoma at a curable stage. Screening tests include chest roentgenograms, three-day "pooled" sputum cytology studies, and lung-health questionnaires. These are being applied every four months to a study population of outpatients who have a high probability of developing lung cancer. Initial patient acceptance of the screening program has been excellent. Small asymptomatic lung cancers have been detected both roentgenographically and cytologically. The two procedures have complemented each other with little overlap. Chest roentgenography has proved most useful in diagnosing peripherally situated cancers, whereas sputum cytology studies have been most effective in identifying early squamous cancer involving major airways. At present, more cancers have been detected roentgenographically than cytologically, but the cytologically detected cases appear to have a better prognosis. Roentgenographically occult cancers have been localized with regularity, although the localization process is complicated. Theoretically, vigorous application of radiologic and cytologic screening, combined with optimum use of localizing procedures and treatment, could increase the five-year survival rate among lung cancer patients to nearly 50 percent. However, the actual survivorship attained will ultimately be determined by currently imponderable factors such as patient acceptance of longterm screening, frequency of multicentric respiratory cancers, and incidence of noncancerous smoking-related diseases, especially chronic obstructive pulmonary disease and ischemic heart disease.
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Martini N, Beattie EJ, Cliffton EE, Melamed MR. Radiologically occult lung cancer. Report of 26 cases. Surg Clin North Am 1974; 54:811-23. [PMID: 4372733 DOI: 10.1016/s0039-6109(16)40384-1] [Citation(s) in RCA: 26] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/10/2023]
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28
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Sanderson DR, Fontana RS, Woolner LB, Bernatz PE, Payne WS. Bronchoscopic localization of radiographically occult lung cancer. Chest 1974; 65:608-12. [PMID: 4832263 DOI: 10.1378/chest.65.6.608] [Citation(s) in RCA: 43] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/12/2023] Open
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Rhodes ML, Bedell GN, Kasik JE, Zavala D, Richardson R. Early detection of lung cancer. Clinical conference from the University of Iowa College of Medicine. Chest 1973; 64:741-6. [PMID: 4357273 DOI: 10.1378/chest.64.6.741] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/10/2023] Open
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Fontana RS, Sanderson DR, Miller WE, Woolner LB, Taylor WF, Uhlenhopp MA. The Mayo Lung Project: preliminary report of "early cancer detection" phase. Cancer 1972; 30:1373-82. [PMID: 5083075 DOI: 10.1002/1097-0142(197211)30:5<1373::aid-cncr2820300535>3.0.co;2-s] [Citation(s) in RCA: 33] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/13/2023]
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