The Egyptian Journal of Bronchology
JUNE 2010 |
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ORIGINAL ARTICLE
RISK OF LUNG CANCER IN PATIENTS WITH PREINVASIVE BRONCHIAL
LESIONS FOLLOWED BY AUTOFLUORESCENCE BRONCHOSCOPY AND CHEST COMPUTED TOMOGRAPHY
By
Mohamed Alaa,1,3 Kiyoshi Shibuya,1,4 Taiki Fujiwara,1 Hironobu Wada,1 Hidehisa Hoshino,1 Shigetoshi Yoshida,1 Makoto Suzuki,1 Kenzo Hiroshima,2 Yukio Nakatani,2 Aliae Mohamed-Hussein,3 Maha Elkholy,3 Tarek Mahfouz,3 Ichiro Yoshino1
1Departments of Thoracic Surgery, 2Basic Pathology, Graduate School of Medicine, Chiba University, Chiba, Japan, 3Department of Chest Diseases and Tuberculosis, Faculty of Medicine, Assiut University, Assiut, Egypt, 4Department of Chest Surgery, Matsudo City Hospital, Matsudo, Japan.
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To assess risk of lung cancer (LC) in patients with preinvasive bronchial lesions and to identify factors associated with higher risk, 124 patients with one or more preinvasive bronchial lesions and normal chest computed tomography (CT) (mean age 66.7 years, 121 males and 3 females), followed-up by white light and autofluorescence bronchoscopy (AFB) every 4-6 mo and chest CT every 6-12 mo, end points were development of carcinoma in situ (CIS) or LC. Among 124 patients with 240 preinvasive bronchial lesions, 20 CIS or LC lesions were detected during follow-up in 20 (16%) patients, 7 were detected as new endobronchial lesions, 10 as new peripheral lesions and 3 as local progression from severe dysplasia to CIS. Median time to progression was 24 months (range: 6-54 mo). The Cumulative risk of progression was 7% at one year, 20% at three years and 44% at 5 years. Among detected lung cancers, 80% were stage 0 or stage І and underwent treatment with curative intent. Diagnosis of new SD during follow-up (p=0.0001), chronic obstructive pulmonary disease (COPD) (p = 0.001) or smoking index >52 packyear (p = 0.042) was associated with higher risk. Even after controlling for other risk factors,COPD was associated with risk of progression. Baseline lesion grade was not predictive of patient outcome (p = 0.146).Patients with preinvasive bronchial lesions, especially those with new SD during follow-up, COPD or smoking >52 pack-year are at high risk of LC, AFB and CT follow-up facilitated early detection and treatment with curative intent.
Keywords: Lung cancer, Autofluorescence bronchoscopy, preinvasive bronchial lesion,squamous dysplasia, early detection.
Abbreviations: AFB= Autofluorescence Bronchoscopy, WLB= White light bronchoscopy, CT= Computed Tomography, COPD= Chronic Obstructive Pulmonary Disease, LC= Lung Cancer, CIS= Carcinoma in situ, BCH= Basal Cell Hyperplasia, SM= Squamous Metaplasia, SD= Squamous Dysplasia.
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