title: Follow-up of bronchial precancerous lesions and carcinoma in situ using fluorescence endoscopy.
abstract: Little is known about the natural history of precancerous bronchial lesions. Histological changes occurring in 416 bronchial intraepithelial lesions (104 high-risk subjects) were assessed over a 2-yr period, using repeated follow-up autofluorescence endoscopies. During the study, 6 of 36 normal epitheliums became dysplastic; 47 of 152 metaplasia evolved to low-grade dysplasia, two progressed to carcinoma in situ, and one to invasive cancer; 6 of 169 low-grade epithelial lesions progressed to a persistent severe dysplasia; 10 of 27 severe dysplastic lesions and 28 of 32 carcinoma in situ persisted or progressed, respectively (p = 0.0005, severe dysplasia versus carcinoma in situ 24 mo outcome). Carcinoma in situ appeared more frequent in patients with a prior history or concomitant cancer (p = 0.003). Persistence of smoking during the study did not influence high-grade lesion outcome. Progression of low-grade epithelial lesions during the study occurred only in patients with at least a high-grade lesion in another site at baseline (9 of 147 lesions, 6.1%). Our study suggests that low-grade epithelial lesions could be safely followed-up at 2 yr in patients without high-grade lesions at baseline, whereas severe dysplasia should be treated if they persist at 3 mo. Immediate treatment of carcinoma in situ appears warranted.
authors.affiliation: Pulmonology Clinic, Department of Occupational Medicine, Rouen, France.
authors.forename: S
authors.initials: S
authors.lastname: Bota
authors.forename: J B
authors.initials: JB
authors.lastname: Auliac
authors.forename: C
authors.initials: C
authors.lastname: Paris
authors.forename: J
authors.initials: J
authors.lastname: Métayer
authors.forename: R
authors.initials: R
authors.lastname: Sesboüé
authors.forename: G
authors.initials: G
authors.lastname: Nouvet
authors.forename: L
authors.initials: L
authors.lastname: Thiberville
mesh_terms: D000328:Adult; D000368:Aged; D001984:Bronchial Neoplasms / Q000453:epidemiology / Q000209:etiology / Q000473:pathology*; D001999:Bronchoscopy / Q000379:methods; D002278:Carcinoma in Situ / Q000453:epidemiology / Q000209:etiology / Q000473:pathology*; D018450:Disease Progression; D005260:Female; D005500:Follow-Up Studies; D005602:France / Q000453:epidemiology; D006801:Humans; D008297:Male; D008875:Middle Aged; D009365:Neoplasm Regression, Spontaneous; D011230:Precancerous Conditions / Q000453:epidemiology / Q000209:etiology / Q000473:pathology*; D012307:Risk Factors; D012907:Smoking / Q000009:adverse effects