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Localized peribronchial thickening: A CT sign of occult bronchogenic carcinoma
Abstract
Localization of sputum-positive but radiologically occult bronchogenic carcinomas is usually accomplished by endobronchial brushing and/or biopsy under fiberoptic bronchoscopy. However, occasionally bronchoscopy is initially unsuccessful, and interval follow-up bronchoscopies or other methods are required to secure precise preoperative tumor localization. We present a case with repeated positive sputum cytologies in which CT proved complementary to nonlocalizing endoscopies by identifying bronchogenic carcinoma as focal peribronchial thickening. Careful preparation of the surgical specimen provided precise pathologic correlation of the CT findings with a small squamous cell carcinoma.
... Initially CT scan it was used for the diagnosis of intraacranial pathology only but later on it was realized that it is an important tool in assessing thoracic, abdominal and pelvic reasons also. Together with Allen Cormack, Hounsfield was awarded Nobel Prize in 1979 for his Revolutionary achievement [1] . CT and HRCT how largely replaced radiological procedures such has bronchography and pulmonary angiography for evolution of parenchyma lung diseases. ...
... Careful preoperative bronchoscopic and cytologic evaluation enables to exclude some tumors with extrabronchial invasion [15,17]. High-resolution computed tomography or transbronchial ultrasonography may detect thickening of the bronchial wall or extrabronchial invasion [18]. We insist again that the resection would be incomplete if preoperative evaluation is not performed carefully. ...
Background:
Roentgenographically occult bronchogenic squamous cell carcinomas (ROSCCs) are early squamous cell lung cancers of central type. Some of them cannot be treated with intrabronchial therapy. Although surgical treatment was performed for such tumors, it was unknown whether lobectomy was indispensable or not.
Methods:
The clinicopathologic information of the 58 patients who underwent segmentectomy for ROSCCs were collected from 16 hospitals and reviewed retrospectively, compared with 98 patients who underwent lobectomy for ROSCCs.
Results:
Five-year survival rate of the 58 patients based on lung cancer deaths was 96.8%, and 82.6% including all causes of death. The duration of chest tube drainage in the segmentectomy group was slightly longer than in the lobectomy group. Operative mortality and the frequency of postoperative complications were not statistically different in both groups. Postoperative/preoperative vital capacity and forced expiratory volume in 1 second were higher in the segmentectomy group.
Conclusions:
These results suggest that segmentectomy may be an alternative for surgical therapy of carefully selected ROSCCs. More prospective studies are required to fully demonstrate clinical benefit.
Objective
To report pulmonary squamous cell carcinomas presenting as localized, long, continuous, bronchial thickening on computed tomography (CT).
Materials and methods
This study comprised five men (mean age, 66 years; range, 60–79 years) with pulmonary squamous cell carcinoma, including two (0.6%) selected from 310 consecutive patients with the diagnosis. Inclusion criteria were as follows: histological diagnosis obtained from thickened bronchi; continuous bronchial thickening > 5 cm in longitudinal extension on CT. CT scans were retrospectively reviewed, focusing on bronchial abnormalities. They were correlated with histopathological findings in four patients who underwent lobectomy.
Results
On initial CT, bronchial thickening was continuous without skip area (n = 5), measured 56–114 mm in maximum longitudinal length, involved lobar (n = 3) or segmental and distal bronchi (n = 5) of the right upper (n = 4) or lower (n = 1) lobe, and was focally bulbous (n = 2). Follow-up CT before treatment, available in two, showed progression of bronchial thickening in its thickness and longitudinal length (n = 2) and a new bulbous portion (n = 1) and peribronchial nodules (n = 1) along the thickened bronchi. Cancer recurred after lobectomy in two, one of which manifested as continuous bronchial thickening extending from the bronchial stump on CT. On CT-histopathological correlation, bronchial thickening was mostly due to tumor spreading along the bronchus. A focal or short segmental tumor outgrowth from the thickened bronchi corresponded to a nodule or bulbous portion along thickened bronchi on CT, respectively.
Conclusion
Pulmonary squamous cell carcinoma may present as localized, long, continuous, bronchial thickening on CT, simulating benign infectious or inflammatory diseases.
Primary central airway neoplasms are rare. These neoplasms present with symptoms of airway obstruction and hemoptysis. Oftentimes,
the diagnosis is delayed because of the late presentation of symptoms. Multidetector CT is the imaging modality of choice
for diagnosis, staging, and preoperative planning of central airway tumors. The differential diagnosis of central airway neoplasms
is broad, but five histologies comprise the majority of lesions. Whereas multidetector CT imaging features can help distinguish
benign from malignant entities, only rarely can imaging alone provide a specific diagnosis. Secondary airway malignancies
and non-neoplastic processes are mimickers of central airway tumors.
Surgery for lung cancer has evolved dramatically over the years. Although 5-year survival for patients with lung cancer remains low, new surgical techniques have increased survival rates for different stages of lung cancer. The article reviews the stages of lung cancer, the different surgical techniques used to treat lung cancer, and the complications of those surgical techniques.
Bronchography is seldom recommended today to localize radiographically and bronchoscopically occult bronchogenic carcinoma. We report a case in which bronchography promptly localized such a tumor that had been occult to multiple bronchoscopies and chest computed tomograms (CTs). The patient is free of recurrence 32 months after lobectomy. Bronchography should be considered when bronchoscopies and CT fail to reveal a radiographically occult carcinoma.
Bronchial stenosis is a complication of tuberculous parenchymal or lymph node disease and may adversely affect its treatment. Findings on plain radiographs may be nonspecific or simulate malignancy. The purpose of this study was to evaluate the role of CT in diagnosing this abnormality. We reviewed the findings in 28 patients who underwent CT to evaluate bronchial stenosis proved by bronchoscopy. Eighteen had evidence of tuberculosis on bronchial biopsy. In the other 10 the biopsy findings were nonspecific, but tuberculous lesions were elsewhere in the thorax. Twelve patients (43%) had CT findings of concentric bronchial stenosis, uniform thickening of the bronchial wall, and involvement of a long segment of the bronchi. In 14 patients (50%), CT showed obliteration of bronchial outlines by adjacent lymphadenopathy, parenchymal consolidation, and absence of intraluminal air. In two patients, the abnormality was not visible on CT. Our experience shows that CT is useful for identifying bronchial stenosis caused by tuberculosis. However, the findings vary, and in more than half of the patients concentric narrowing and uniform thickening of the bronchi are not seen.
The positive bronchus sign is the CT finding of a bronchus leading to or contained within the primary mass. A prospective study was performed for the purpose of establishing the correlation between the above sign on CT and the visual and pathological findings on bronchoscopy. The predictive value for the positive bronchus sign was found to be 94% and that of the negative bronchus sign 62%. CT is useful in predicting the likelihood of subsequent bronchoscopy providing positive results.
A prospective evaluation of segmental and subsegmental bronchi of 104 right and 109 left lungs was made from oblique CT scans of patients with normal airways. The frequency of identification of each of these bronchi was compared with the results of a similar retrospective analysis of 107 right and 113 left lungs, studied with standard vertical CT slices. The percent visualization of all bronchial ramifications is tabulated, allowing us to state that the 20 degrees cranially oblique slice considerably improves CT analysis of the bronchial tree. Several potential uses of oblique CT are discussed and applied to bronchial disease evaluation.
Management of patients with central airways tuberculosis differs according to the activity of the disease. The purpose of this study was to analyze CT findings of active and fibrotic disease in patients with central airways tuberculosis.
According to bronchoscopic findings and biopsy results, 41 patients with tuberculosis of the trachea and main bronchi were categorized as having active disease (n = 30) or fibrotic disease (n = 11). Follow-up CT scans were obtained after antituberculous therapy in 11 patients with active disease and two patients with fibrotic disease. All CT scans were retrospectively analyzed with particular attention to the locations of airway lesions, patterns of luminal narrowing, wall thickening of diseased airways, and presence of abnormal adjacent lymph nodes.
Active disease in 30 patients involved the trachea (n = 20), the right main bronchus (n = 14), or the left main bronchus (n = 13). Seventeen patients had multiple lesions. On CT scans, these airways showed irregular (n = 24) or smooth (n = 4) narrowing in 28 patients: minimal (n = 5) or marked (n = 18) wall thickening with contrast enhancement in 23 patients: and obstruction with peribronchial cuffing in nine patients. Enlarged mediastinal lymph nodes were seen in 26 patients. Fibrotic disease in 11 patients involved the trachea (n = 6), the right main bronchus (n = 2), or the left main bronchus (n = 9). Six patients had multiple lesions. On CT scans, the airways showed smooth (n = 7) or irregular (n = 2) narrowing without (n = 5) or with minimal (n = 4) wall thickening in nine patients and obstruction without peribronchial cuffing in four patients. On follow-up CT scans, the findings for the airway lesions were almost normal in nine patients who had had initial active disease. However, the findings for airway narrowing did not change in two patients with fibrotic disease after 6 months of follow-up.
Principal CT findings in our patients depended on disease stage. Central airways narrowing was seen in both active and fibrotic stages. However, in patients with active disease, CT scans showed irregular and thick-walled airways, a pattern that was reversible, whereas patients with fibrotic disease generally had smooth narrowing of airways and minimal wall thickening, a pattern that was not reversible during the follow-up period.
Sputum cytology is useful for screening and diagnosis of centrally located lung cancer in Japan. On the other hand, cancer beyond the range of bronchoscopic visibility in X-ray negative patients can be detected only with difficulty. Of 265 patients detected by sputum cytology in mass screening, 85 had an abnormal chest roentgenogram and the remaining 180 were roentgenographically occult. A total of 200 roentgenographically occult squamous cell carcinoma lesions were detected in the above 180 patients. A total of 45 of the 200 lesions were bronchoscopically occult. Twenty-two of the above 45 lesions were beyond the range of bronchoscopic visibility with a standard bronchoscope. The data obtained show that a sputum cytology positive, X-ray negative squamous cell carcinoma may lie outside the reach of a flexible bronchoscope. Thus, when it is difficult to localize a cancer, brushing of the peripheral bronchi beyond bronchoscopic visibility and chest computed tomography should be performed.
Despite current advances in diagnosis, staging, and treatment, carcinoma of the lung remains the leading cause of death from cancer in both men and women. Non-small cell lung cancer represents approximately 80% of all new lung cancer cases; however, only one-third of these cases will undergo surgical resection for tumor control. This article reviews the evaluation, latest revisions in staging, and surgical management of non-small cell lung cancer.
In order to determine the appropriate treatment modality for roentgenographically occult bronchogenic squamous cell carcinoma (ROSCC), it is essential to evaluate the depth of invasion, because ROSCC invading beyond the cartilaginous layer cannot be effectively treated by photodynamic therapy (PDT) due to spread of disease. Transtracheal endoscopic ultrasonography (TUS) was useful for predicting the depth of invasion in some ROSCCs. In order to assess the actual significance of TUS as a diagnostic tool for predicting the depth of carcinoma invasion, we have conducted a prospective trial with 22 lesions of ROSCCs. We ultrasonographically classified the degree of the depth of invasion into two groups; A: "invasion does not reach cartilaginous layer" and B: "invasion involves cartilaginous layer". Then the patients were treated by irradiation, PDT, or surgical resection. Pathological findings were also classified into A or B. In order to calculate the sensitivity for evaluating the depth of invasion by TUS, the cases without any tumor and/or malignant cells after PDT were regarded as pathological A. In the evaluation of the depth of carcinoma invasion staying inside the cartilaginous layer, the sensitivity and the positive predictive value were 85.7%, the specificity was 66.7%, and the accuracy was 80.0%. With TUS, preoperative evaluation of the depth of invasion would be more accurate, and the decision of treatment modality would be more appropriate, compared with the conventional bronchoscopic observation alone.
Computed tomography (CT) can be used to diagnose both inflammatory and neoplastic diseases that arise from or affect the bronchi. The clarity of anatomic detail that can be obtained with CT is demonstrated. This clarity of anatomic detail should be of use in those cases for which bronchoscopy, mediastinoscopy, or other staging procedures are planned. The overall usefulness of CT in patients with bronchial lesions has yet to be established.
Of the 10,040 men who are enrolled in the New York Early Lung Cancer Detection program, 206 have now developed carcinoma of the lung, and 107 (52%) have been treated by complete resection. One hundred forty-seven lung cancers (71%) were detected and diagnosed by the screening examination; 59 were interval cases diagnosed because of symptoms or on x-rays taken elsewhere. Of the former group, 93 (63%) were completely resected, whereas only 14 (24%) of the latter group were resectable. Survival without regard to tumor stage or cell type is estimated to be 65% at 6 years for the carcinomas treated by complete resection, and 8% at 4 years for all others.Sur 10040 hommes qui se soumirent la dtection prcoce du cancer du poumon New York, 206 ont t atteints d'un cancer du poumon et 107 (52%) ont t traits par exrse. Cent-quarante-et-un cancers du poumon (71%) furent dcels par l'exploration systmatique; 59 cas furent dcels en raison de l'existence de symptmes ou de clichs thoraciques pratiqus ailleurs. Alors que dans le 1er groupe 93 (63%) subirent une exrse complte, la rsection fut possible chez 14 malades dans le second groupe (24%). Le taux de survie, sans tenir compte du stade tumoral ou du type cellulaire a t de 65% 6 ans pour les cancers traits par exrse complte et seulement de 8% 4 ans chez les autres.
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