Objective: To assess the prevalence of synchronous
roentgenographically occult lung carcinoma (ROLC) in patients with
resectable roentgenographically visible lung cancer (RVLC).
Methods: Patients undergoing surgery for RVLC in the same
University Hospital were prospectively evaluated before surgery by
fluorescence bronchoscopy under local anesthesia to detect synchronous
ROLC. All abnormal areas, with the exception of the RVLC, had biopsies
Results: From June 1996 to January 1999, 43
patients (male/female ratio: 1.7/1.0) were evaluated before lobectomy
(n = 34) or pneumonectomy (n = 10) for 44 primary RVLC. There were
10 T1N0, 19 T2N0, 1 T1N1, 9 T2N1, 1 T3N0, 3 T1N2, and 1 T3N1 lesions.
The histologic type was mainly squamous carcinoma (n = 21) and
adenocarcinoma (n = 14). All but two patients were smokers or
ex-smokers (mean ± SD, 48 ± 28 pack-years). A total of 177
endobronchial biopsies were performed (4.1 ± 2.5); 8 were too small
to be informative, 43 showed non-preneoplastic alterations, and 50 were
normal. There were 7 basal cell hyperplasias, 56 metaplasias, 9
dysplasias, and 4 carcinomas in situ (CIS). All the
dysplasias and CIS lesions were observed in eight subjects. The
synchronous CIS were treated by surgery (n = 1) or localized
therapeutic modalities (n = 3).
high prevalence of synchronous early lung cancers (9.3%) as well as
metaplasia and dysplasia in this series of patients with resectable
RVLC suggests that fluorescence bronchoscopy may be a useful adjunct in
the preoperative evaluation of lung cancer.