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Synchronous Roentgenographically Occult Lung Carcinoma in Patients With Resectable Primary Lung Cancer^*

^* From the Chest Service, CHU of Charleroi, Charleroi (Dr. Pierard); Departments of Internal Medicine (Drs. Berghmans and Sculier) and Pathology (Dr. Roufosse), Institut Bordet; and Chest Service (Drs. Vermylen and Ninane) and Thoracic Surgery Service (Dr. Bosschaerts), Saint-Pierre Hospital, Brussels, Belgium.

Correspondence to: V. Ninane, MD, Chest Service, Saint-Pierre Hospital, Rue Haute, 322, 1000 Brussels, Belgium

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 made.

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).

Conclusions: The 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.

Key Words: fluorescence bronchoscopy • lung cancer • roentgenographically occult lung cancer

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