Synchronous roentgenographically occult lung carcinoma in patients with resectable primary lung cancer

Objective: To assess the prevalence of synchronous roentgenographically occ ult lung carcinoma (ROLC) in patients with resectable roentgenographically visible lung cancer (RVLC). Methods: Patients undergoing surgery for RVLC in the same University Hospit al were prospectively cly evaluated before surgery by fluorescence bronchos copy 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) f or 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 endobronchi al biopsies were performed (4.1 +/- 2.5); 8 were too small to be informativ e, 43 showed non-preneoplastic alterations, and 50 were normal. There were 7 basal cell hyperplasias, 56 metaplasias, 9 dysplasias, and 4 carcinomas i n situ (CIS). All the dysplasias and CIS lesions were observed in eight sub jects. The synchronous CIS were treated by surgery (n = 1) or localized the rapeutic modalities (n = 3). Conclusions: The high prevalence of synchronous early lung cancers (9.3%) a s well as metaplasia and dysplasia in this series of patients with resectab le RVLC suggests that fluorescence bronchoscopy may be a useful adjunct in the preoperative evaluation of lung cancer.