Diagnóstico precoz del cáncer de pulmón

[Proposed terms for endobronchial lesions in patients suspected of having a bronchial neoplasm]

Endoscopists describe lung cancer lesions using varying terminology. This study aimed to assess the probability of neoplastic disease in terms of endoscopic findings expressed in an original classification system. The endoscopic lesions were classified as infiltrations (superficial lesions without a clear border with normal mucosa) or masses (exophytic lesions easily distinguished from the bronchial wall). Each lesion was categorized according to 3 grades reflecting probability of malignancy. A grade I infiltration was a lesion presenting 1 of the following characteristics: loss of luster, increased thickness, or redness, with a smooth surface. A grade II infiltration presented 2 of the aforementioned characteristics, with a rough surface. A grade III infiltration presented 3 of those characteristics. A grade I mass was an exophytic lesion with a smooth surface, uniformly colored. A grade II mass presented a smooth surface of a distinct color, and a grade III mass had a rough surface and irregular coloring. We assessed 377 patients with suspicion of neoplasm. Twenty-three percent of the infiltrations were grade I carcinomas, 74% were grade II, and 95% were grade III. Twenty-three percent of masses were grade I, 77% were grade II, and 97% were grade III. The probability of malignancy increased significantly with grade (P< .001) for both types of lesion. In summary, there is a positive correlation between the terms used and the probability of carcinoma. Most grade III lesions were carcinomas, but apparently innocuous grade I lesions could be carcinomas in a significant number of cases.

Low-dose CT: a useful and accessible tool for the early diagnosis of lung cancer in selected populations

OBJECTIVE

An evaluation is made of the effectiveness of low-dose computed tomography (LDCT) in diagnosing early stage lung cancer in the Autonomous Community of Madrid (Spain).

METHODS

The study comprised subjects over 50 years of age who were active smokers (or who had stopped smoking up to 6 months previously) who smoked more than 30 cigarettes daily for at least 15 years, or 20 cigarettes daily for 20 years, or more than 10packs/year and in contact with asbestos at work. The study group was evaluated using LDCT. For all participants in whom LDCT showed no pathological findings, or in those cases classified as benign, a new LDCT scan was performed 2 years after the first. In case of doubt regarding the benign nature of the findings, an assessment algorithm was applied.

RESULTS

Among the initial 482 candidates in the study group, 466 LDCT scans were performed at baseline, revealing 9 extrapulmonary lesions and 114 pulmonary lesions in 98 subjects. The latter raised diagnostic doubts in 32 cases; of these, 15 were confirmed as benign by high resolution computed tomography (HRCT). In the remaining 17 cases, stage IAp adenocarcinoma was diagnosed at baseline (0.2%). With LDCT after 2 years, an additional four adenocarcinomas were diagnosed-all in stage IAp (0.98%). The complete study, including prevalence cut-off and incidence calculation after 2 years, resulted in the diagnosis of five cancers (1.1%) and two false positive cases (28%).

CONCLUSIONS

The use of low-dose computed tomography in risk groups is valid for the early diagnosis of bronchogenic cancer. Nevertheless, significant problems remain, particularly those associated with false positive interpretations. The results of randomized studies on lung cancer mortality such as the US NLST trial and the Dutch-Belgian NELSON trial have to be awaited before any conclusion regarding the effectiveness of LDCT screening can be drawn.

[Stage I nonsmall cell lung cancer up to 3 cm in diameter. Prognostic factors]

OBJECTIVE

To assess the prognostic value of a series of clinicopathological variables in stage I nonsmall cell lung cancer, for tumors up to 3 cm in diameter.

PATIENTS AND METHOD

The study included 271 patients. Survival was analyzed with the Kaplan-Meier method. The Cox model was used for multivariate analysis.

RESULTS

Five- and ten-year survival were 78.63% and 67.59%, respectively. Survival did not significantly depend on sex, age, extent of resection, histology, visceral pleural invasion, level of bronchial invasion or T1 versus T2. The decade in which resection was performed did affect survival (P=.0037). Five-year survival was 58% for operations between 1970 and 1980, 77% for operations between 1981 and 1990, and 84% for operations between 1991 and 2000. Tumor size also affected survival (P=.0046), which was 86% for patients with tumors of less than or equal to 2 cm in diameter and 73% for those with tumors of more than 2 cm in diameter. In the multivariate analysis both variables entered into regression, remaining predictive of survival.

CONCLUSION

We found evidence for a prognostic stage migration (Will Rogers phenomenon) according to the decade in which resection was performed and that tumor size affected survival in our population. Finally, the current system of TNM staging fails in conforming groups of patients with a homogenous prognosis.