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Ann Thorac Surg 2000;70:1179-1180
© 2000 The Society of Thoracic Surgeons
a Department of Chest Surgery, Kanazawa Medical University, Uchinada, Ishikawa 920-0293, Japan
e-mail: yohwata{at}kanazawa-med.ac.jp
Early lung cancers in both central and peripheral locations are curable diseases if they are properly diagnosed and treated. According to our data [1] the ratio of central-type lung cancer (localized proximal to segmental bronchus) to peripheral-type lung cancer (arising in the subsegmental bronchus or distal thereto) was 187 to 800 (1:4.3). Koike and colleagues showed excellent surgical outcomes for central-located early stage lung cancer.
To date, there is no internationally approved definition of early hilar lung cancer. In Japan, the pathological criteria for diagnosing early hilar lung cancer are as follows: (1) Lesions are localized proximal to the segmental bronchus. (2) The depth of tumor invasion is confined to within the bronchial wall. (3) There are no lymph node metastases or distant metastases. By this definition, most of the patients with early hilar lung cancers show long-term survival, so these definition criteria are commonly used in Japan [2].
According to Koike and colleagues, 83 (83.8%) of 99 lesions located proximal to the segmental bronchus met the above criteria. They also included 16 other lesions that were located distal to the subsegmental bronchus, but they designated them, as a whole, "centrally-located" early stage lung cancer.
The incidence of early hilar lung cancer was 98 (4.7%) in 2,093 resected lung cancers in that authors’ series and, in our series, it was 45 (3.7%) of 1216 resected lung cancers (between 1985 and 1999) and 15.1% of 301 hilar (proximal to the segmental bronchus) lung cancers. Pathologically, there were 10 cases of carcinoma in situ (10.4% of 96 squamous cell carcinoma) in that authors’ series. In our series, there were 13 carcinoma in situ (28.9%) in 45 patients. The reason for the relatively high incidence of carcinoma in situ in our series may be partly ascribed to our recent use of fluorescence endoscopy (LILE system) [3] for diagnosis of minute lesions that were detected by mass screening of sputum cytology. Koike and coworkers noticed 10.2% incidence of a second primary centrally-located lung cancer. Our series found an 11.1% (5 of 45) incidence of a second primary hilar lung cancer. These findings and the collective review done by Koike and coworkers (Table 6) suggest that we should repeat periodic sputum cytology, bronchoscopic examination, or fluorescence endoscopy for the early detection of second primary lung cancers during the follow-up period.
For the treatment of early hilar lung cancer, all of our patients were treated with surgical resection, and our preferred operative procedure has been a parenchymal-sparing operation to preserve lung function [4, 5]. However, retrospectively, recent photodynamic therapy (PDT) using a photosensitizer could have been selected in some cases in which the lesions were minute and localized.
There is controversy concerning the validity of mass examination for lung cancer. However, as Koike and coworkers pointed out, there were no occult lung cancers before the start of mass screening projects. In our series, 44.4% (20 of 45) of early hilar lung cancer were detected by mass screening of sputum cytology. I completely agree with Koike and colleagues that mass screening of sputum cytology is valuable for detecting early hilar lung cancer.
References
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