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High Prevalence of Endobronchial Malignancy in High-Risk Patients With Moderate Dysplasia in Sputum*

Timothy C. Kennedy, MD, FCCP; Wilbur A. Franklin, MD; Sheila A. Prindiville, MD; Robert Cook, MD; Edward C. Dempsey, MD; Robert L. Keith, MD, FCCP; Fred R. Hirsch, MD; Thomas A. Merrick, MD; Kenneth R. Shroyer, MD; Thomas L. Petty, MD, Master FCCP; Tim Byers, MD; Paul A. Bunn, Jr, MD; York E. Miller, MD
Author and Funding Information

*From the Specialized Program of Research Excellence (SPORE) in Lung Cancer; University of Colorado Cancer Center (Drs. Franklin, Prindiville, Cook, Hirsch, Byers, and Bunn); Denver Veterans Affairs Medical Center (Drs. Dempsey, Keith, Shroyer, and Miller); and Lung Cancer Institute of Colorado/HealthOne Alliance (Drs. Kennedy, Merrick, and Petty), Denver, CO.

Correspondence to: Timothy C. Kennedy, MD, FCCP, Lung Cancer Institute of Colorado, 1721 E 19th Ave, Rm 366, Denver, CO 80218; e-mail: TCHESK@aol.com



Chest. 2004;125(5_suppl):109S. doi:10.1378/chest.125.5_suppl.109S
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We tested the hypothesis that moderate dysplasia in sputum is an important indicator of occult central airway lung cancer in high-risk subjects (defined as those having ≥ 30 pack-years of tobacco smoking and airflow obstruction).

The study population (79 patients) was defined as follows: (1) current or former heavy smokers with at least 30 pack-years of cigarette use; (2) airflow obstruction, defined by an FEV1 of < 75% predicted and an FEV1/FVC ratio of < 75%; (3) moderate dysplasia in sputum cytology; and (4) no evidence of malignancy on a chest radiograph at the time that bronchoscopy was scheduled. Lung cancer was found by combined white-light and fluorescence bronchoscopy in 5 of 79 consecutive high-risk subjects (6.3%; 95% confidence interval [CI], 0.7 to 11.7%). Three cancers were invasive and two were carcinoma in situ. Seven additional subjects (8.9%; 95% CI, 2.6 to 15.0%) had severe dysplasia. Thus, 12 of 79 patients (15.2%; 95% CI, 7.2 to 23.2%) had malignancy or severe preneoplastic changes. Moderate dysplasia in sputum appears to be an important marker of risk for occult endobronchial malignancy in high-risk subjects.

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