Clinical characteristics and survival of patients with surgically resected, incidentally detected lung cancer

Increased use of computed tomography in Denmark: stage shift toward early stage lung cancer through incidental findings

BACKGROUND

Computed tomography (CT) examinations are increasingly used worldwide and incidental findings are growing likewise. Lung cancer stage at diagnosis is pivotal to survival. The earliest stage of lung cancer, stage IA is in most cases asymptomatic. Potentially, increased use of clinical CTs could induce a stage shift toward earlier lung cancer diagnosis.

MATERIALS AND METHODS

Data on the number of CT thorax in Denmark and the stage distribution of Danish lung cancer patients 2013-2020 were acquired from, respectively, the Danish Health Data Authority and the Danish Lung Cancer Registry. Clinical auditing of stage IA lung cancer patients was performed in the period 2019-2021 in a Danish region to assess the reasons for referral. Auditing of stage IV lung cancer patients was done to see whether a CT thorax was performed in a two-year period before diagnosis.

RESULTS

All regions showed an increase in CTs per 1000 inhabitants. However, the number of CTs performed in 2013 differed by more than 50% among regions, and the increase per year also differed, from an increase of 1.9 to 3.4 more examinations per year. A significant correlation between CTs and fraction of stage IA lung cancers was seen in four out of the five regions. The audit of stage IA lung cancer cases revealed that 86.8% were incidental findings. Audit of stage IV lung cancer found that 4.3% had a nodule/infiltrate on a previous CT within a 2-year period prior to the diagnosis of lung cancer that was the probable origin of stage IV lung cancer.

CONCLUSION

The study found that the vast majority of early-stage lung cancers were incidental findings. It highlights that follow-up algorithms of incidental findings should be used in accordance with guidelines and it should be unequivocally how the CT follow-up of pulmonary infiltrates is managed.

Stage I lung cancer patients with or without symptoms - are the patients different and should we treat them differently?

INTRODUCTION

A large proportion of stage I cancers are found incidentally, which appears to be a prognostic factor. We investigated stage I lung cancers according to whether, or not, there had been clinical suspicion of lung cancer prior to referral and to see, if we could detect any difference regarding patient characteristics, work-up and mortality for incidental vs non-incidental findings as well as for asymptomatic vs symptomatic patients.

METHODS

Medical records and referral documents for 177 patients diagnosed with stage I lung cancer were reviewed and divided based on whether the initial CT scan leading to diagnosis had been made due to suspicion of lung cancer or not. Patient characteristics and mortality between groups were compared, as well as mortality between patients with and without symptoms at the time of diagnosis.

RESULTS

One-hundred-and-eight patients were diagnosed incidentally, while 69 patients were non-incidental findings. Among the incidental findings, 55% had no symptoms, whereas none in the non-incidental group were asymptomatic. Personal characteristics were comparable between the groups. Significantly more patients in the incidental group had malignant comorbidity. Non-malignant chronic co-morbidity was more prevalent in the non-incidental group, in particular lung disease. There was no difference in tumour size, histology, or survival for incidental vs non-incidental or for asymptomatic vs symptomatic patients.

CONCLUSION

A large proportion of stage I lung cancers are found incidentally, especially in patients with malignant co-morbidity. We found no difference in survival to indicate that we did or should handle these patient groups differently.

Prognostic value of symptoms at lung cancer diagnosis: a three-year observational study

Background

Lung cancer is mainly diagnosed at advanced or locally advanced stages, usually when symptoms become evident. However, sometimes it may be diagnosed incidentally during routine care, while patients are still asymptomatic. Prognosis differences based on symptomatic presentation have been partially explored. Our aim was to analyze the prognostic value of the initial symptomatic state of the patients in a general lung cancer cohort.

Methods

Observational ambispective study including patients consecutively diagnosed with primary lung cancer between January 2016 and December 2018 via the lung cancer Fast Diagnostic Track (FDT). Patients were followed up until death or the end of the study in September 2019. Asymptomatic patients were compared with patients presenting symptoms. Overall survival (OS) of both groups was compared using the log-rank test. Cox regression analysis was performed to clarify the effect of the symptomatic status at diagnosis on survival. Additionally, propensity score (PS) matching analysis was performed.

Results

A total of 267 patients were analyzed; 83.5% were men, with a mean (SD) age at diagnosis of 68 (10.7) years. Incidental diagnosis was ascertained in 24.7% of cases. Asymptomatic patients presented more frequently stage I and II disease compared to symptomatic patients (51.5% vs. 14%), and exhibited a significantly better prognosis, with a 3-year OS of 63.6% (vs. 30.3%) and a median OS that was not reached during follow-up (vs. 10.3 months). With an adjusted multivariate Cox proportional hazard model, we obtained a HR (95% CI) of 2.63 (95% CI, 1.6-4.2; P<0.0001) associated with symptomatic presentation independently of age, sex, stage at diagnosis and ECOG scale. In addition, after performing the propensity score matching analysis, the Cox regression model continued to show a significantly worse prognosis for patients presenting with symptoms (P=0.041).

Conclusions

Lung cancer patients who are asymptomatic at diagnosis exhibit a significantly better prognosis, regardless of the stage of the disease, underlining the importance of an early diagnosis.

Oncologic Outcomes of Surgery Versus SBRT for Non-Small-Cell Lung Carcinoma: A Systematic Review and Meta-analysis

BACKGROUND

The optimal treatment of stage I non-small-cell lung carcinoma is subject to debate. The aim of this study was to compare overall survival and oncologic outcomes of lobar resection (LR), sublobar resection (SR), and stereotactic body radiotherapy (SBRT).

METHODS

A systematic review and meta-analysis of oncologic outcomes of propensity matched comparative and noncomparative cohort studies was performed. Outcomes of interest were overall survival and disease-free survival. The inverse variance method and the random-effects method for meta-analysis were utilized to assess the pooled estimates.

RESULTS

A total of 100 studies with patients treated for clinical stage I non-small-cell lung carcinoma were included. Long-term overall and disease-free survival after LR was superior over SBRT in all comparisons, and for most comparisons, SR was superior to SBRT. Noncomparative studies showed superior long-term overall and disease-free survival for both LR and SR over SBRT. Although the papers were heterogeneous and of low quality, results remained essentially the same throughout a large number of stratifications and sensitivity analyses.

CONCLUSION

Results of this systematic review and meta-analysis showed that LR has superior outcomes compared to SBRT for cI non-small-cell lung carcinoma. New trials are underway evaluating long-term results of SBRT in potentially operable patients.

Differences in lung cancer characteristics and mortality rate between screened and non-screened cohorts

Screening programs for lung cancer aim to allow diagnosis at the early stage, and therefore the decline in mortality rates. Thus, the aim of this retrospective cohort study was to the comparison of screened and non-screened lung cancer in terms of lung cancer characteristics, overdiagnosis and survival rate. A retrospective study in which 2883 patients with 2883 lung cancer diagnosed according to the hospital-based lung cancer register database between 2007 and 2017. A comparison was performed in term of clinical characteristics and outcomes of lung cancer between the screened and non-screening patient groups. 2883 subjects were identified (93 screened and 2790 non-screened). Screened group patients were younger (59.91 ± 8.14 versus 67.58 ± 12.95; p < 0.0001), and were more likely to be female than non-screened group (61.3% versus 36.8%; p < 0.0001). The screened group showed significantly better outcomes in overall mortality than the non-screened group (10.75% versus 79.06%; <0.0001). In a Cox proportional hazard model, lung cancer in the screened group proved to be an independent prognostic factor in lung cancer subjects. Our findings point to the improved survival outcome in the screened group and might underline the benefit of low-dose computed tomography (LDCT) screening program in Asian populations with the high prevalence of non-smoking-related lung cancer. Further study aimed at the LDCT mass screening program targeting at light smokers and non-smoker outside of existing screening criteria is warranted.

Pilot study of a video intervention to reduce anxiety and promote preparedness for lung cancer screening

BACKGROUND

Lung cancer screening (LCS) with low dose computed tomography (LDCT) is associated with a 20% reduction in lung cancer mortality. Psychological burden is a potential harm associated with LCS, and is a major barrier to utilization. We aimed to examine the feasibility and acceptability of a video intervention designed to reduce anxiety and promote psychological preparedness of LCS.

PATIENTS AND METHODS

This is a two group, sequential enrollment pilot study of a video intervention that integrates information on screen criteria, procedures, benefits and harms, and follow-up plan. Participants were enrolled 1-2 weeks prior to baseline LDCT, and the intervention was administered in one in-person session on the day of LDCT. Outcomes were assessed at baseline (pre-screen), immediately after LDCT, and at 1 week, 3 months, and 7 months post-screen. Outcome measures included the SF-12 (HRQOL), STAI (anxiety), psychosocial consequences of LCS (COS-LC), risk perceptions for lung cancer, and a satisfaction tool. The student's t-test was used for exploratory evaluations on change from baseline scores both within and between groups.

RESULTS

Sixteen participants (8 intervention, 8 controls) enrolled and completed the study (61.5% retention). Participants in the control group reported a significantly increased sense of dejection at 1-month and 7-months post-screen as measured by the COS-LC (p = 0.01). Participants were highly satisfied with the intervention.

CONCLUSION

A video intervention that promoted psychological preparedness for LCS was feasible to implement as part of an LCS program and highly accepted by participants.

Incidental detection by computed tomography is an independent prognostic factor for survival in patients operated for nonsmall cell lung carcinoma

We studied the rate of incidental detection of lung carcinomas and its effect on long-term survival in a nationwide cohort of patients operated for nonsmall cell lung cancer (NSCLC).

All patients operated for NSCLC in Iceland during 1991–2010 were included. Demographic and clinicopathological features were compared in patients diagnosed incidentally using chest radiography or computed tomography (CT), and in those with symptomatic presentation. Multivariate analysis was used to evaluate prognostic factors.

Out of 508 patients, 174 (34%) were diagnosed incidentally; in 26% of cases by chest radiography and in 8% by CT. The CT-detected tumours were significantly smaller than symptomatic tumours, diagnosed at earlier TNM (tumour, node and metastasis) stages and more often of adenocarcinoma histology. 5-year cancer-specific survival for symptomatic versus incidentally diagnosed patients detected by chest radiography and CT was 41%, 57% and 68%, respectively (p=0.003). After adjusting for stage, the hazard ratio (HR) for NSCLC mortality was significantly lower for incidental diagnosis by CT (HR 0.55, 95% CI 0.31‒0.98; p=0.04) compared to incidental diagnosis by chest radiography (HR 0.95, 95% CI 0.70‒1.27; p=0.71) or symptomatic diagnosis (HR 1.0).

One-third of surgically treated NSCLCs were detected incidentally, with an increasing rate of incidental CT diagnosis. NSCLC patients diagnosed incidentally by CT appear to have better survival than those diagnosed incidentally by chest radiography, and particularly those who present with symptoms.

A third of surgically treated NSCLC cases were detected incidentally; those detected by CT may have better survivalhttp://ow.ly/S24I309M1VK

Lung Cancer Screening

Lung cancer is the leading cause of cancer mortality in the United States and worldwide. Since lung cancer outcomes are dependent on stage at diagnosis with early disease resulting in longer survival, the goal of screening is to capture lung cancer in its early stages when it can be treated and cured. Multiple studies have evaluated the use of chest X-ray (CXR) with or without sputum cytologic examination for lung cancer screening, but none has demonstrated a mortality benefit. In contrast, the multicenter National Lung Screening Trial (NLST) from the United States found a 20 % reduction in lung cancer mortality following three consecutive screenings with low-dose computed tomography (LDCT) in high-risk current and former smokers. Data from European trials are not yet available. In addition to a mortality benefit, lung cancer screening with LDCT also offers a unique opportunity to promote smoking cessation and abstinence and may lead to the diagnoses of treatable chronic diseases, thus decreasing the overall disease burden. The risks of lung cancer screening include overdiagnosis, radiation exposure, and false-positive results leading to unnecessary testing and possible patient anxiety and distress. However, the reduction in lung cancer mortality is a benefit that outweighs the risks and major health organizations currently recommend lung cancer screening using age, smoking history, and quit time criteria derived from the NLST. Although more research is needed to clearly define and understand the application and utility of lung cancer screening in the general population, current data support that lung cancer screening is effective and should be offered to eligible beneficiaries.

Clinical characteristics and prognosis of incidentally detected lung cancers

Objective. To evaluate clinical characteristics and outcomes in incidentally detected lung cancer and in symptomatic lung cancer. Material and Methods. We designed a retrospective study including all patients undergoing pulmonary resection with a curative intention for NSCLC. They were classified into two groups according to the presence or absence of cancer-related symptoms at diagnosis in asymptomatic (ASX)—incidental diagnosis—or symptomatic. Results. Of the 593 patients, 320 (53.9%) were ASX. In 71.8% of these, diagnosis was made by chest X-ray. Patients in the ASX group were older (P = 0.007), had a higher prevalence of previous malignancy (P = 0.002), presented as a solitary nodule more frequently (P < 0.001), and were more likely to have earlier-stage disease and smaller cancers (P = 0.0001). A higher prevalence of incidental detection was observed in the last ten years (P = 0.008). Overall 5-year survival was higher for ASX (P = 0.001). Median survival times in pathological stages IIIB-IV were not significantly different. Conclusion. Incidental finding of NSCLC is not uncommon even among nonsmokers. It occurred frequently in smokers and in those with history of previous malignancy. Mortality of incidental diagnosis group was lower, but the better survival was related to the greater number of patients with earlier-stage disease.

Differences in clinical presentation of non-small cell lung cancer in never-smokers versus smokers

OBJECTIVES

This study was conducted to evaluate whether or not tumor spread and the diagnostic process in non-small cell lung cancer (NSCLC) is different based on smoking history.

METHODS

Associations between smoking status and clinical presentation were evaluated controlling for the effect of histology. Lung cancer with delayed diagnosis (LCDD) and incidental detection (LCID) were determined based on medical records.

RESULTS

Of 914 patients, frequency of distant metastases was more common in never-smokers than in smokers (59% and 36%, respectively; P<0.001). Although never-smokers were more likely to have LCDD than smokers (18% and 11%, respectively; P=0.038), LCDD were not significantly associated with frequency of distant metastases [49% (LCDD) vs. 42% (non-LCDD); P=0.189] as well as tumor [29% (T3-4) vs. 24% (T1-2); P=0.134] and node [43% (N2-3) vs. 44% (N0-1); P=0.838] stage. Interestingly, never-smokers are more likely to have LCID than smokers (31% and 19%, respectively; P=0.010). In survival analysis, LCID (P=0.001; HR, 0.63) remained a prognostic factor, while LCDD did not.

CONCLUSIONS

This study suggests distinct metastatic pattern and diagnostic processes of never-smokers. The link between survival and incidental detection was also indicated.

Screening for Lung Cancer: Who Should Be Screened?

Lung cancer is the most common cause of death from cancer in the United States. Previous studies of screening with chest radiographs and sputum cytology have not been shown to decrease lung cancer mortality. For the first time, a randomized screening trial with low-dose computed tomography scans has demonstrated a 20% lung cancer mortality reduction compared with screenings with a chest x-ray. Investigation is underway on many breath, sputum, and blood biomarkers to determine markers of high risk. The hope is that some (or one) of them will add to the early detection of lung cancer observed with low-dose computed tomography.

Initial medical attention on patients with early-stage non-small cell lung cancer

BACKGROUND

Detection of early stage non-small cell lung cancer (NSCLC) is commonly believed to be incidental. Understanding the reasons that caused initial detection of these patients is important for early diagnosis. However, these reasons are not well studied.

METHODS

We retrospectively reviewed medical records of patients diagnosed with stage I or II NSCLC between 2000 and 2009 at UT MD Anderson Cancer Center. Information on suggestive LC-symptoms or other reasons that caused detection were extracted from patients' medical records. We applied univariate and multivariate analyses to evaluate the association of suggestive LC-symptoms with tumor size and patient survival.

RESULTS

Of the 1396 early stage LC patients, 733 (52.5%) presented with suggestive LC-symptoms as chief complaint. 347 (24.9%) and 287 (20.6%) were diagnosed because of regular check-ups and evaluations for other diseases, respectively. The proportion of suggestive LC-symptom-caused detection had a linear relationship with the tumor size (correlation 0.96; with p<.0001). After age, gender, race, smoking status, therapy, and stage adjustment, the symptom-caused detection showed no significant difference in overall and LC-specific survival when compared with the other (non-symptom-caused) detection.

CONCLUSION

Symptoms suggestive of LC are the number one reason that led to detection in early NSCLC. They were also associated with tumor size at diagnosis, suggesting early stage LC patients are developing symptoms. Presence of symptoms in early stages did not compromise survival. A symptom-based alerting system or guidelines may be worth of further study to benefit NSCLC high risk individuals.

Clinical features of bronchioloalveolar carcinoma with new histologic and staging definitions

INTRODUCTION

To assess clinical features of bronchioloalveolar carcinoma (BAC) based on the 1999 World Health Organization Classification ("pure BAC"), compare patients with pure BAC with patients previously diagnosed as BAC not meeting the 1999 definition, and compare survival changes of pure BAC based on the old and new (2009) staging systems.

METHODS

A pulmonary pathologist reviewed each BAC tumor diagnosed between January 1, 1997, and December 31, 2007, identifying cases meeting the new criteria. Cases were restaged according to the seventh edition of the tumor, node, metastasis classification introduced in 2009. Patients with pure BAC were analyzed under both staging systems for changes in overall survival estimation.

RESULTS

Of 338 total patients who were diagnosed with BAC, 117 were classified as pure and 221 were non-pure BAC. Seventy-eight of the 117 and 178 of the 221 had no other primary lung cancer. One-year and 5-year survival for the 78 patients with pure BAC were 94.8 and 83.5%, and for the 178 patients were 92.6 and 46.4%, respectively. Restaging for pure BAC cases resulted in nine of the 78 cases (12%) changing stage. Compared with the old staging, patients with advanced stage under the new stage had a worse 5-year survival (53% versus 45%), but no change was observed for stage IA.

CONCLUSIONS

For patients with pure BAC, the new pathologic system favorably affects survival and the new staging system may more accurately reflect prognosis in advanced stage cancer. Our results have important implications for researchers, clinicians, and patients.

[Reason for a medical visit in the diagnosis of lung cancer. A review of 481 cases]

INTRODUCTION

Lung cancer is the most frequent cancer death related cause in the world. Its clinical presentation usually corresponds to advanced stages. The indication of screening programs for the diagnosis in early phases has been debated for years.

AIMS

To know the clinical characteristics in the presentation of the lung cancer in our health care area.

MATERIAL AND METHODS

All of the incident lung cancer cases for 3 years (January 1, 1997 to December 31, 1999) among those patients with usual residence in the Santiago de Compostela health care area were retrospectively collected from the available information in the Codification Service. The histological type was graded according to the World Health Organization classification. Date of death was obtained from the patient's clinical history, mortality record, or telephonic calls to the patient's home. The rest of the information was obtained from the clinical records of the patient and Pathology Service.

RESULTS

Four-hundred and eighty-one lung cancer cases were diagnosed (incident gross rate of 41.79 per 100,000 inhabitants and year). Median age was 66.9 years (interquartile range 60.5-74.4), 92.77% being males and 94.1% corresponding to smokers or former smokers. The most prevalent symptoms motivating the visit were general syndrome (20%), thoracic pain (19%) and hemoptisis (17%). A group of patients (56), fundamentally males, had an incidental diagnosis.

CONCLUSIONS

The incidence of lung cancer seems to be high in our health care area. The standard patient with lung cancer in this health care area is a 67-year-old, male, who smokes, diagnosed in advanced stages, who consults due to a general syndrome and/or chest pain. Some of the symptoms appear with significant gender differences. Likewise, there are differences between histologies, the high frequency of chest pain in adenocarcinoma being outstanding, although it is also the first cause for consultation in small cell lung cancer. On the contrary, hemoptisis, the most frequent consultation cause in squamous cell carcinoma and the general syndrome in the big cells type or with clinical-radiological diagnosis.

Natural history, growth kinetics, and outcomes of untreated clinically localized renal tumors under active surveillance

BACKGROUND

The growth kinetics of untreated solid organ malignancies are not defined. Radiographic active surveillance (AS) of renal tumors in patients unfit or unwilling to undergo intervention provides an opportunity to quantify the natural history of untreated localized tumors. The authors report the radiographic growth kinetics of renal neoplasms during a period of surveillance.

METHODS

The authors identified patients with enhancing renal masses who were radiographically observed for at least 12 months. Clinical and pathological records were reviewed to determine tumor growth kinetics and clinical outcomes. Tumor growth kinetics were expressed in terms of absolute and relative linear and volumetric growth.

RESULTS

The authors identified 172 renal tumors in 154 patients under AS. Median tumor diameter and volume on presentation were 2.0 cm (mean, 2.5; range, 0.4-12.0) and 4.18 cm(3) (mean, 20.0; range, 0.033-904). Median duration of follow-up was 24 months (mean, 31; range, 12-156). A significant association between presenting tumor size and proportional growth was noted, with smaller tumors growing faster than larger tumors. Thirty-nine percent (68 of 173) of tumors underwent delayed intervention, and 84% (57 of 68) were pathologically malignant. Progression to metastatic disease was noted in 1.3% (2 of 154) of patients.

CONCLUSIONS

The authors demonstrated the association between a tumor's volume and subsequent growth, with smaller tumors exhibiting significantly faster volumetric growth than larger tumors, consistent with Gompertzian kinetics. Surveillance of localized renal tumors is associated with a low rate of disease progression in the intermediate term, and suggests potential overtreatment biases in select patients.

A multigene assay is prognostic of survival in patients with early-stage lung adenocarcinoma

PURPOSE

Clinical staging does not adequately risk stratify patients with early stage non-small cell lung cancer. We sought to generate a real-time PCR (RT-PCR)-based prognostic model in patients with early stage lung adenocarcinoma, the dominant histology of lung cancer in the United States.

EXPERIMENTAL DESIGN

We studied gene expression of 61 candidate genes in 107 patients with completely surgically resected lung adenocarcinoma using RT-PCR. We used crossvalidation methods to select and validate a prognostic model based on the expression of a limited number of genes. A risk score was generated based on model coefficients, and survival of patients with high- and low-risk scores were analyzed.

RESULTS

We generated a four-gene model based on expression of WNT3a, ERBB3, LCK, and RND3. Risk score predicted mortality better than clinical stage or tumor size (adjusted hazard ratio, 6.7; 95% confidence interval, 1.6-28.9; P=0.001). Among 70 patients with stage I disease, 5-year overall survival was 87% among patients with low-risk scores, and 38% among patients with high-risk scores (P=0.0002). Among all patients, 5-year overall survival was 62% and 41%, respectively (P=0.0054). Disease-free survival was also significantly different among low- and high-risk score patients.

CONCLUSIONS

This multigene assay predicts overall and disease-free survival significantly better than clinical stage and tumor size in patients with early stage lung adenocarcinoma and performs especially well in patients with stage I disease. Prospective clinical trials are needed to determine whether high-risk patients with stage I disease benefit from adjuvant chemotherapy.

Natural History of Stage I Non-Small Cell Lung Cancer

BACKGROUND

Concern has been raised that early detection of lung cancer may lead to the treatment of clinically indolent cancers. No population-based study has examined the natural history of patients with stage I NSCLC who receive no surgery, chemotherapy, or radiation therapy. Our hypothesis is that long-term survival in patients with untreated stage I non-small cell lung cancer (NSCLC) is uncommon.

METHODS

A total of 101,844 incident cases of NSCLC in the California Cancer Center registry between 1989 and 2003 were analyzed; 19,702 patients had stage I disease, of whom 1,432 did not undergo surgical resection or receive treatment with chemotherapy or radiation. Five-year overall survival (OS) and lung cancer-specific survival were determined for this untreated group, for subsets of patients who were recommended but refused surgical resection, and for T1 tumors.

RESULTS

Only 42 patients with untreated stage I NSCLC were alive 5 years after diagnosis. Five-year OS for untreated stage I NSCLC was 6% overall, 9% for T1 tumors, and 11% for patients who refused surgical resection. Five-year lung cancer-specific survival rates were 16%, 23%, and 22%, respectively. Among these untreated patients, median survival was 9 months overall, 13 months for patients with T1 disease, and 14 months for patients who refused surgical resection.

CONCLUSION

Long-term survival with untreated stage I NSCLC is uncommon, and the vast majority of untreated patients die of lung cancer. Given that median survival is only 13 months in patients with T1 disease, surgical resection or other ablative therapies should not be delayed even in patients with small lung cancers.

Diagnosis and treatment of bronchioloalveolar carcinoma

PURPOSE OF REVIEW

Bronchioloalveolar carcinoma accounts for 5% of lung cancers, although histologically mixed bronchioloalveolar carcinoma and adenocarcinoma account for up to 20%. Bronchioloalveolar carcinoma histology is present in a majority of tumors found on lung-cancer screening by computed tomography. We review issues surrounding the diagnosis and treatment of bronchioloalveolar carcinoma, which often differs from other types of lung cancer.

RECENT FINDINGS

A spectrum of disease from histologically pure bronchioloalveolar carcinoma to adenocarcinoma exists. The approach to treatment of diseases within this spectrum is still evolving. Evidence on the role of sub-lobar resection, resection of multifocal disease, and pulmonary transplantation is reviewed. We also discuss epidermal growth factor receptor tyrosine kinase inhibitors, and their role in patients with bronchioloalveolar carcinoma.

SUMMARY

An understanding of recent developments in the diagnosis and treatment of patients with bronchioloalveolar carcinoma histology is important as early detection of lung cancer becomes more common. Ongoing clinical trials will provide important information on the role of limited resection. The use of epidermal growth factor receptor tyrosine kinase inhibitors should currently be limited to patients with advanced or recurrent disease who have failed cytotoxic chemotherapy. New targeted therapies are emerging for patients with bronchioloalveolar carcinoma histology.