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Diagnosis and Management of Lung Cancer: ACCP Guidelines (2nd Edition) |

Bronchial Intraepithelial Neoplasia/Early Central Airways Lung Cancer*: ACCP Evidence-Based Clinical Practice Guidelines (2nd Edition)

Timothy C. Kennedy, MD, FCCP; Annette McWilliams, MD, FCCP; Eric Edell, MD, FCCP; Tom Sutedja, MD, PhD FCCP; Gordon Downie, MD, PhD, FCCP; Rex Yung, MD, FCCP; Adi Gazdar, MD; Praveen N. Mathur, MBBS, FCCP
Author and Funding Information

*From the University of Colorado Health Sciences Center (Dr. Kennedy), Division of Pulmonary Critical Care Medicine, Denver, CO; British Columbia Cancer Research Center (Dr. McWilliams), Vancouver, BC, Canada; Mayo Clinic (Dr. Edell), Rochester, MN; Vrije Universiteit Academic Hospital (Dr. Sutedja), Amsterdam, the Netherlands; East Carolina University (Dr. Downie), Greenville, NC; Johns Hopkins University (Dr. Yung), Baltimore, MD; Southwestern Medical School (Dr. Gazdar), Dallas, TX; and Indiana University School of Medicine (Dr. Mathur), Indianapolis, IN.

Correspondence to: Praveen N. Mathur, MBBS, FCCP, 550 W University Blvd, Suite 4903, Indianapolis IN 46202; e-mail: pmathur@IUPUI.edu



Chest. 2007;132(3_suppl):221S-233S. doi:10.1378/chest.07-1377
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Background: An evidence-based approach is necessary for the localization and management of intraepithelial and microinvasive non-small cell lung cancer in the central airways.

Methods: Material appropriate to this topic was obtained by literature search of a computerized database. Recommendations were developed by the writing committee and then reviewed by the entire guidelines panel. The final recommendations were made by the Chair and were voted on by the entire committee.

Results: White light bronchoscopy has diagnostic limitations in the detection of microinvasive lesions. Autofluorescence bronchoscopy (AFB) is a technique that has been shown to be a sensitive method for detecting these lesions. In patients with moderate dysplasia or worse on sputum cytology and normal chest radiographic findings, bronchoscopy should be performed. If moderate/severe dysplasia or carcinoma in situ (CIS) is detected in the central airways, then bronchoscopic surveillance is recommended. The use of AFB is preferred if available. In a patient being considered for curative endobronchial therapy to treat microinvasive lesions, AFB is useful. A number of endobronchial techniques as therapeutic options are available for the management of CIS and can be recommended to patients with inoperable disease. In patients with operable disease, surgery remains the mainstay of treatment, although patients may be counseled about these techniques.

Conclusions: AFB is a useful tool for the localization of microinvasive neoplasia. A number of endobronchial techniques available for the curative treatment can be considered first-line therapy in inoperable cases. For operable cases, the techniques may be considered and discussed with the patients.


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