S. Bota et al., Follow-up of bronchial precancerous lesions and carcinoma in situ using fluorescence endoscopy, AM J R CRIT, 164(9), 2001, pp. 1688-1693
Little is known about the natural history of precancerous bronchial lesions
. Histological changes occurring in 416 bronchial intraepithelial lesions (
104 high-risk subjects) were assessed over a 2-yr period, using repeated fo
llow-up autofluorescence endoscopies. During the study, 6 of 36 normal epit
heliums became dysplastic; 47 of 152 metaplasia evolved to low-grade dyspla
sia, two progressed to carcinoma In situ, and one to invasive cancer; 6 of
169 low-grade epithelial lesions progressed to a persistent severe dysplasi
a; 10 of 27 severe dysplastic lesions and 28 of 32 carcinoma in situ persis
ted or progressed, respectively (p = 0.0005, severe dysplasia versus carcin
oma in situ 24 mo, outcome). Carcinoma in situ appeared more frequent in pa
tients with a. prior history or concomitant cancer (p = 0.003). Persistence
of smoking during the study did not influence high-grade lesion outcome. P
rogression of low-grade epithelial lesions during the study occurred only i
n patients with at least a high-grade lesion in another site at baseline (9
of 147 lesions, 6.1%). Our study suggests that low-grade epithelial lesion
s could be safely followed-up at 2 yr in patients without high-grade lesion
s at baseline, whereas severe dysplasia, should be treated if they persist
at 3 mo. Immediate treatment of carcinoma in situ appears warranted.