The bronchial spread of lung cancer

Cotton, R. E.

doi:10.1016/s0007-0971(59)80004-8

Cited by 46 publications

(19 citation statements)

References 12 publications

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“…20 Many but not all studies of positive margins of surgically treated lung cancers have shown adverse impact by residual disease. [1][2][3][4][5][6][7][8][9][10][11][12][13][14][15][16] Microscopic residual tumor at the bronchial resection margin has then been divided into different patterns. Cotton 1 first divided microscopic residual disease into mucosal tumor (spreading from a mucosal lesion), and extramucosal microscopic residual disease (tumor involving peribronchial soft tissues or tumor within lymphatics).…”

Section: Discussionmentioning

confidence: 99%

“…Cotton 1 first divided microscopic residual disease into mucosal tumor (spreading from a mucosal lesion), and extramucosal microscopic residual disease (tumor involving peribronchial soft tissues or tumor within lymphatics). 1 Extramucosal tumor had a worse prognosis. Soorae divided microscopic residual disease into four patterns: direct submucosal extension of invasive cancer, carcinoma in situ, tumor present in lymphatics at the margin, and parabronchial invasive tumor.…”

Section: Discussionmentioning

confidence: 99%

“…18 Suggested 'safe distances' for length of bronchial margins have ranged from 1.5 to 2 cm. 1,18,19,22 Some authors have suggested taking longer margins for adenocarcinoma (1.5 cm for squamous cell carcinoma, 2.0 cm for adenocarcinoma. 22 Studies of lung cancer series report a wide range of positive margins, with rates of 1.1-17% of cases having residual tumor at the bronchial margin.…”

Section: Discussionmentioning

confidence: 99%

“…To this end, resection margins should be uninvolved with tumor. Many surgical series have demonstrated adverse patient outcome with either microscopic or macroscopic residual tumor at the bronchial resection margin, [1][2][3][4][5][6][7][8][9][10][11][12][13] and thus it is usually assumed that negative margins give the best chance for local control. However, poor outcomes with residual microscopic disease have not been reported by all authors.…”

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Bronchial margins in lung cancer resection specimens: utility of frozen section and gross evaluation

2004

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Pathology reports for all lobectomy and pneumonectomy specimens at UNC Hospitals between 1991 and 2000 (n ¼ 405) were reviewed for correlation between frozen section and final bronchial margin, gross distance between tumor and margin and tumor type. Frozen section was performed in 268 cases (66%). A total of 243 were true negatives (90.6 %), 16 (6.0%) were true positives, four (1.5%) were false positives and five (1.9%) were false negatives. The site of tumor in true-positive cases was mucosal (11), submucosal (three), lymphatics (one), peribronchial (one). The site of tumor in false-negative cases was submucosal (two), lymphatics (one), peribronchial (two). In 137 cases, no bronchial frozen section was performed; there was one case (0.7%) with positive margin. There was no correlation between final margin positivity and distance between gross tumor and margin. Tumor distance to margin in positive margin cases varied from grossly involved to 3 cm away. There were 72 cases in which wedge resection was performed before lobectomy in which no gross tumor remained in the lobectomy, and in all cases final bronchial margins were negative. In all, 373 of cases (92%) were nonsmall carcinomas. Of these, 10 (2.7%) had positive margins. Tumors other than nonsmall cell carcinoma accounted for a disproportionate number of positive margins. In all, 3/6 of adenoid cystic/ mucoepidermoid carcinoma, 1/7 small cell carcinoma and 1/1 lymphoma cases had positive margins. In conclusion, frozen section evaluation of bronchial margins is helpful in central lung tumors. Mucosal tumor is preferentially identified in frozen section. Gross evaluation of margins is problematic, as intramucosal carcinoma or tumor in lymphatics may not be detected, but 3 cm was a 'safe' distance for gross tumor from margin. In lobectomies following wedge resection in which no gross tumor remained, all had negative margins. Salivary gland-type tumors have a high incidence of positive margins, and frozen section is particularly indicated in these tumors.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

mentioning

confidence: 99%

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Bronchial margins in lung cancer resection specimens: utility of frozen section and gross evaluation

2004

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“…6,7 While the mucosal tumor usually presents as exophytic mass within the lumen of a bronchus, the endoscopic evidences of submucosal and peribronchial tumors may be more subtle in presentation, as: erythema, loss of normal bronchial markings, bronchial narrowing, thickening of the mucosal stripes, or extrinsic compression of the bronchus. 4 Although the diagnostic yield of bronchoscopic forceps biopsy is very high for exophytic masses, submucosal or peribronchial disease is more difficult to sample through the standard forceps biopsy.…”

Section: Discussionmentioning

confidence: 99%

Diagnostic yield of conventional transbronchial needle aspiration in suspected bronchogenic carcinoma without intraluminal growth on bronchoscopy

2017

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Background: Bronchogenic carcinoma with spread along the mucosal plane presents as an exophytic mass. Most of the submucosal and peribronchial patterns of this malignancy are harder to detect by standard diagnostic procedures such as bronchial washing, brushing and forceps biopsy. We sought to investigate the utility of transbronchial needle aspiration (TBNA) in the diagnosis of bronchogenic carcinoma without intraluminal mass, through prospective analysis of routine diagnostic bronchoscopies performed in a 24-month period, at a tertiary care hospital.Methods: Patients with suspected bronchogenic carcinoma (clinical and radiological) underwent standard computed tomography (CT) of thorax. Further the patients were subjected to conventional TBNA, singly, and in combination with bronchial washings and brushings. The results were analyzed statistically for the diagnostic yield of TBNA.Results: Among the 42 patients assessed, 29 had malignancy confirmed by forceps biopsy or CT guided Fine Needle aspiration cytology or biopsy and bronchoscopy. Among them, 17 cases were detected by a combination of the results of bronchial washing, brushing and TBNA. The individual sensitivities amounted to 3.4% (n=1), 51.72% (n=15) and 27.6% (n=8), respectively. There were no false positive results. Concerning different bronchoscopic sampling techniques, 9 cases were diagnosed solely by bronchial brushings and 2 cases by TBNA alone. No periprocedural complications were encountered.Conclusions: Value of bronchial brushing in the diagnosis of bronchogenic carcinoma without bronchoscopically visible intraluminal mass is above that of conventional TBNA. Addition of bronchial washings, to bronchial brushings and TBNA has an insignificant impact on the diagnosis.

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Maligne Lungentumoren

Meister¹

1986

Chirurgische Onkologie

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The bronchial spread of lung cancer

Cited by 46 publications

References 12 publications

Bronchial margins in lung cancer resection specimens: utility of frozen section and gross evaluation

Bronchial margins in lung cancer resection specimens: utility of frozen section and gross evaluation

Diagnostic yield of conventional transbronchial needle aspiration in suspected bronchogenic carcinoma without intraluminal growth on bronchoscopy

Maligne Lungentumoren

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