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(Chest. 2004;125:109S.)
© 2004 American College of Chest Physicians

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 and York E. Miller, MD

* 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{at}aol.com

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.


   Footnotes
 
Abbreviation: CI = confidence interval

This project was supported by Public Health Service grant Lung Cancer SPORE P50 CA 58187 from the National Cancer Institute, National Institutes of Health, Department of Health and Human Services, by the HealthOne Alliance Foundation (Denver, CO), and by Xillix Technologies, Vancouver, BC, Canada.





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