Surveillance for the detection of early lung cancer in patients with bronchial dysplasia.
BACKGROUND
The natural history of bronchial preinvasive lesions and the risk of developing lung cancer in patients with these lesions are not clear. Previous studies have treated severe dysplasia and carcinoma in situ (CIS) on the assumption that most will progress to invasive carcinoma.


OBJECTIVE
To define the natural history of preinvasive lesions and assess lung cancer risk in patients with these lesions.


OBJECTIVE
Most preinvasive lesions will not progress to invasive carcinoma but patients with these lesions will be at high risk.


METHODS
A cohort of patients with preinvasive lesions underwent fluorescence bronchoscopy every 4-12 months and computed tomography of the chest annually. The main end point was the development of invasive carcinoma.


RESULTS
22 patients with 53 lesions were followed up for 12-85 months. 11 cancers were diagnosed in 9 patients. Of the 36 high-grade lesions (severe dysplasia and CIS), 6 progressed to invasive cancers. 5 separate cancers developed at remote sites in patients with high-grade lesions. All cancers were N0M0 and curative treatment was given to 8 of the 9 patients. The cumulative risk of developing lung cancer in a patient with a high-grade lesion was 33% and 54% at 1 and 2 years, respectively. Of the 17 low-grade lesions, none progressed to invasive carcinoma.


CONCLUSIONS
Although the risk of malignant progression of individual preinvasive lesions is relatively small, patients with high-grade lesions are at high risk of lung cancer. Surveillance facilitated early detection and treatment with curative intent in most patients.
Jeremy George
Philip
P
Centre for Respiratory Research, Department of Medicine, University College London, London UK. jeremy.george@uclh.org
Banerjee
Anindo K
AK
Read
Catherine A
CA
O'Sullivan
Caoihme
C
Falzon
Mary
M
Pezzella
Francesco
F
Nicholson
Andrew G
AG
Shaw
Penny
P
Laurent
Geoff
G
Rabbitts
Pamela H
PH
D000368:Aged; D001984:Bronchial Neoplasms / Q000473:pathology / Q000517:prevention & control*; D001999:Bronchoscopy / Q000379:methods*; D002278:Carcinoma in Situ / Q000473:pathology*; D015331:Cohort Studies; D042241:Early Diagnosis; D004847:Epithelial Cells / Q000473:pathology; D005260:Female; D005453:Fluorescence; D005500:Follow-Up Studies; D006801:Humans; D008137:Longitudinal Studies; D008175:Lung Neoplasms / Q000473:pathology / Q000517:prevention & control*; D008297:Male; D008875:Middle Aged; D011230:Precancerous Conditions / Q000473:pathology*; D012307:Risk Factors; D014057:Tomography, X-Ray Computed / Q000379:methods