Background: The ability of conventional CT scans and
fiberoptic bronchoscopy to localize and properly stage radiographically
occult lung cancer (ROLC) in the major airways is limited.
High-resolution CT (HRCT) scanning and autofluorescence bronchoscopy
(AFB) may improve the assessment of ROLC before the most appropriate
therapy can be considered.
Patients and methods: We
prospectively studied 23 patients with ROLC, who were referred for
intraluminal bronchoscopic treatment (IBT) with curative intent.
Additional staging with HRCT and AFB was performed prior to treatment.
Twenty patients were men, 9 patients had first primary cancers, and 14
patients had second primary cancers or synchronous cancers.
Results: HRCT scanning showed that 19 patients (83%) had
no visible tumor or enlarged lymph nodes. With AFB, only 6 of the 19
patients (32%) proved to have tumors ≤ 1 cm2 with
visible distal margins. They were treated with IBT. In the remaining 13
patients, abnormal fluorescence indicated more extensive tumor
infiltration than could be seen with conventional bronchoscopy
alone. Six patients underwent radical surgery for stage T1–2N0
(n = 5) and stage T2N1 (n = 1) tumors. Specimens showed that
tumors were indeed more invasive than initially expected. The remaining
seven patients technically did not have operable conditions, so they
were treated with external irradiation (n = 4) and IBT (n = 3). The
range for the time of follow-up for all patients has been 4 to 58
months (median, 40 months). The follow-up data underscore the
correlation between accurate tumor staging and survival.
Conclusions: Our data showed that 70% of patients
presenting with ROLC had a more advanced cancer than that initially
diagnosed, which precludes IBT with curative intent. Additional staging
with HRCT and AFB enabled better classification of true occult cancers.
Our approach enabled the choice of the most appropriate therapy for
each individual patient with ROLC.