Endoscopic evaluation of centrally located early squamous cell carcinoma of the lung

BACKGROUND, Lung-sparing treatment recently has become a choice in the trea tment of patients with early hilar lung carcinoma. To select the method of treat ment, it is important to evaluate the histologic extent of the tumor using endoscopy. METHODS. A total of 46 patients who underwent surgery for an endoscopically evaluated early lung carcinoma of the tracheobronchial tree were analyzed. Initial surgery was performed in 16 patients and in 30 patients surgery wa s performed after preoperative laser therapy. The endoscopic findings were classified into three types: superficial, nodular, and polypoid. In the res ected lung, the greatest turner dimension, the depth of mural invasion, the presence of microscopic blood and lymph vessel invasion, and metastases to the dissected lymph nodes were examined. RESULTS. The mean greatest tumor dimensions were 14.6 +/- 7.3 mm (mean +/- standard deviation) in the nodular group, 23.3 +/- 12.8 mm in the superfici al group, and 19.0 +/- 9.2 mm in the polypoid group. The greatest tumor dim ension in the superficial group was significantly larger than that in the n odular group (P < 0.01]. Preoperative endoscopic diagnosis of early hilar l ung carcinoma was correct histologically in 34 of 46 cases (74.0%). Hilar l ymph node metastases (N1), extrabronchial invasion, and extension to the pe ripheral bronchus were recognized in 12 cases. Complete disappearance of th e tumor due to preoperative laser therapy was confirmed in eight patients. Lymph node metastasis was not found when the greatest tumor dimension measu red < 8 mm. The overall absolute 5-year survival rate was 76.0% for all pat ients, 87.1% for the surgery alone group, and 70.0% for the surgery after p reoperative laser therapy group. CONCLUSIONS. Curative treatment of early hilar lung carcinoma is possible u sing photodynamic therapy alone when the tumor size is less than or equal t o 8 mm and the lesion does not extend to the peripheral bronchus. Cancer 20 01;91:1142-7. (C) 2001 American Cancer Society.