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Guisier F, Deslee G, Birembaut P, Escarguel B, Chapel F, Bota S, Métayer J, Lachkar S, Capron F, Homasson JP, Taulelle M, Quintana M, Raspaud C, Messelet D, Benzaquen J, Hofman P, Baddredine J, Paris C, Cales V, Laurent P, Vignaud JM, Ménard O, Copin MC, Ramon P, Bouchindhomme B, Tavernier JY, Quintin I, Quiot JJ, Galateau-Sallé F, Zalcman G, Piton N, Thiberville L. Endoscopic follow-up of low-grade precancerous bronchial lesions in high-risk patients: long-term results of the SELEPREBB randomised multicentre trial. Eur Respir J 2022; 60:13993003.01946-2021. [PMID: 35236723 DOI: 10.1183/13993003.01946-2021] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2021] [Accepted: 01/15/2022] [Indexed: 01/29/2023]
Abstract
BACKGROUND 3-9% of low-grade preinvasive bronchial lesions progress to cancer. This study assessed the usefulness of an intensive bronchoscopy surveillance strategy in patients with bronchial lesions up to moderate squamous dysplasia. METHODS SELEPREBB (ClinicalTrials.gov NCT00213603) was a randomised study conducted in 17 French centres. After baseline lung computed tomography (CT) and autofluorescence bronchoscopy (AFB) to exclude lung cancer and bronchial severe squamous dysplasia or carcinoma in situ (CIS), patients were assigned to standard surveillance (arm A) with CT and AFB at 36 months or to intensive surveillance (arm B) with AFB every 6 months. Further long-term data were obtained with a median follow-up of 4.7 years. RESULTS 364 patients were randomised (A: 180, B: 184). 27 patients developed invasive lung cancer and two developed persistent CIS during the study, with no difference between arms (OR 0.63, 95% CI 0.20-1.96, p=0.42). Mild or moderate dysplasia at baseline bronchoscopy was a significant lung cancer risk factor both at 3 years (8 of 74 patients, OR 6.9, 95% CI 2.5-18.9, p<0.001) and at maximum follow-up (16 of 74 patients, OR 5.9, 95% CI 2.9-12.0, p<0.001). Smoking cessation was significantly associated with clearance of bronchial dysplasia on follow-up (OR 0.12, 95% CI 0.01-0.66, p=0.005) and with a reduced risk of lung cancer at 5 years (OR 0.15, 95% CI 0.003-0.99, p=0.04). CONCLUSION Patients with mild or moderate dysplasia are at very high risk for lung cancer at 5 years, with smoking cessation significantly reducing the risk. Whereas intensive bronchoscopy surveillance does not improve patient outcomes, the identification of bronchial dysplasia using initial bronchoscopy maybe useful for risk stratification strategies in lung cancer screening programmes.
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Affiliation(s)
- Florian Guisier
- Dept of Pneumology, Normandie Univ, UNIROUEN, LITIS Lab QuantIF team EA4108, CHU Rouen and Inserm CIC-CRB 1404, Rouen, France
| | - Gaëtan Deslee
- Dept of Pneumology, CHU de Reims, Inserm UMR 1250, Université de Reims-Champagne Ardenne, Reims, France
| | | | | | - Françoise Chapel
- Laboratoire d'Anatomie Pathologique, CHI Toulon La Seyne sur Mer, Toulon, France
| | | | | | | | | | | | | | | | | | - Daniel Messelet
- Laboratoire d'Anatomie et Cytologie Pathologiques, Toulouse, France
| | - Jonathan Benzaquen
- Dept of Pulmonary Medicine and Oncology, Université Côte d'Azur, Centre Hospitalier Universitaire de Nice, FHU OncoAge, Nice, France.,Institute of Research on Cancer and Aging (IRCAN), Université Côte d'Azur, FHU OncoAge, CNRS UMR7284, INSERM U1081, Nice, France
| | - Paul Hofman
- Institute of Research on Cancer and Aging (IRCAN), Université Côte d'Azur, CNRS, INSERM, Nice, France.,Laboratory of Clinical and Experimental Pathology, Université Côte d'Azur, FHU OncoAge, BB-0033-00025, Centre Hospitalier Universitaire de Nice, Nice, France
| | | | - Christophe Paris
- INSERM U1085 IRSET and Service de Santé au Travail et de Pathologie Professionnelle et Environnementale, CHRU Pontchaillou, Rennes, France
| | - Valérie Cales
- Laboratoire d'Anatomie Pathologique, CH de Pau, Pau, France
| | | | | | - Olivier Ménard
- Service de Pneumologie, CHU Nancy, Hôpital Brabois, Vandoeuvre les Nancy, France
| | | | - Philippe Ramon
- Clinique des Maladies Respiratoires, CHRU Lille, Hôpital Calmette, Lille, France
| | | | | | - Isabelle Quintin
- Service d'Anatomie Pathologique, CHU Brest, Hôpital Morvan, Brest, France
| | | | - Françoise Galateau-Sallé
- Laboratoire d'Anatomie Pathologique, CHU de Caen, Caen, France.,Dept of BioPathology Centre Leon Berard, Lyon, France
| | - Gérard Zalcman
- Service de Pneumologie, CHU de Caen, Caen, France.,Thoracic Oncology Dept, Université de Paris, Hôpital Bichat Claude Bernard, Paris, France
| | - Nicolas Piton
- Service de Pathologie, Normandie Université, UNIROUEN, Inserm U1245, CHU Rouen, Rouen, France
| | - Luc Thiberville
- Dept of Pneumology, Normandie Univ, UNIROUEN, LITIS Lab QuantIF team EA4108, CHU Rouen and Inserm CIC-CRB 1404, Rouen, France
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Preinvasive disease of the airway. Cancer Treat Rev 2017; 58:77-90. [DOI: 10.1016/j.ctrv.2017.05.009] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2016] [Revised: 05/23/2017] [Accepted: 05/27/2017] [Indexed: 01/20/2023]
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Rigden HM, Alias A, Havelock T, O'Donnell R, Djukanovic R, Davies DE, Wilson SJ. Squamous Metaplasia Is Increased in the Bronchial Epithelium of Smokers with Chronic Obstructive Pulmonary Disease. PLoS One 2016; 11:e0156009. [PMID: 27228128 PMCID: PMC4881906 DOI: 10.1371/journal.pone.0156009] [Citation(s) in RCA: 50] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2015] [Accepted: 05/06/2016] [Indexed: 01/05/2023] Open
Abstract
Aims To quantify the extent of squamous metaplasia in bronchial biopsies and relate it to the presence of chronic obstructive pulmonary disease (COPD), a smoking-related pathology. Methods Bronchial biopsies (n = 15 in each group) from smokers with COPD GOLD stage1 and GOLD stage2, smokers without COPD and healthy non-smokers were stained immunohistochemically with a panel of antibodies that facilitated the identification of pseudostratified epithelium and distinction of squamous metaplasia and squamous epithelium from tangentially cut epithelium. The percentage length of each of these epithelial phenotypes was measured as a percent of total epithelial length using computerised image analysis. Sections were also stained for carcinoembryonic antigen and p53, early markers of carcinogenesis, and Ki67, and the percentage epithelial expression measured. Results The extent of squamous metaplasia was significantly increased in both COPD1 and COPD2 compared to healthy smokers and healthy non-smokers. The amount of fully differentiated squamous epithelium was also increased in COPD1 and COPD2 compared to healthy non-smokers, as was the expression of carcinoembryonic antigen. These features correlated with one other. Conclusion In subjects with COPD there is a loss of pseudostratified epithelium accompanied by an increase in squamous metaplasia with transition into a fully squamous epithelium and expression of early markers of carcinogenesis.
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Affiliation(s)
- Helen M. Rigden
- Academic Unit of Clinical and Experimental Sciences, Faculty of Medicine, University of Southampton, Southampton, United Kingdom
| | - Ahmad Alias
- Academic Unit of Clinical and Experimental Sciences, Faculty of Medicine, University of Southampton, Southampton, United Kingdom
| | - Thomas Havelock
- Academic Unit of Clinical and Experimental Sciences, Faculty of Medicine, University of Southampton, Southampton, United Kingdom
- NIHR Southampton Respiratory Biomedical Research Unit, University Hospital Southampton, Tremona Road, Southampton, United Kingdom
| | - Rory O'Donnell
- Academic Unit of Clinical and Experimental Sciences, Faculty of Medicine, University of Southampton, Southampton, United Kingdom
| | - Ratko Djukanovic
- Academic Unit of Clinical and Experimental Sciences, Faculty of Medicine, University of Southampton, Southampton, United Kingdom
- NIHR Southampton Respiratory Biomedical Research Unit, University Hospital Southampton, Tremona Road, Southampton, United Kingdom
| | - Donna E. Davies
- Academic Unit of Clinical and Experimental Sciences, Faculty of Medicine, University of Southampton, Southampton, United Kingdom
- NIHR Southampton Respiratory Biomedical Research Unit, University Hospital Southampton, Tremona Road, Southampton, United Kingdom
| | - Susan J. Wilson
- Academic Unit of Clinical and Experimental Sciences, Faculty of Medicine, University of Southampton, Southampton, United Kingdom
- * E-mail:
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Is there a relationship between the presence of lung mucosa preinvasive lesions and lung cancer incidence? Influence of tobacco consumption. Lung Cancer 2014; 84:134-8. [PMID: 24589076 DOI: 10.1016/j.lungcan.2014.02.003] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2013] [Revised: 02/04/2014] [Accepted: 02/08/2014] [Indexed: 11/20/2022]
Abstract
UNLABELLED Although studied for years, the nature of the relationships between tobacco consumption, bronchial preinvasive lesions and lung cancer are still not completely elucidated. Objectives were to determine the relationship between tobacco consumption and lung mucosa preinvasive and invasive lesions and to describe patients' evolution according to baseline characteristics. METHODS Bronchial biopsy specimens were taken at six predetermined sites in 156 males, current smokers, aged above 18 years. Relationships between smoking characteristics and preinvasive lesions indexes and between baseline characteristics and lung cancer occurrence during a prospective follow-up were examined. RESULTS Maximum grade was hyperplasia for 16.7% of patients, metaplasia 33.3%, dysplasia 25.0%, and carcinoma in situ 1.3%. For 23.7% of patients, all biopsies were considered normal. Preinvasive lesion indexes were related to smoking intensity (cigarettes/day). Lung cancer incidence during the follow-up was 19.9%. No association between severity of mucosa lesions at baseline and incidence of cancer during the follow-up period was observed. CONCLUSION The majority of smokers had mucosa lesions, but a relatively small number of them would have a cancer, and there was a poor correlation between severity of mucosalesions and incidence of cancer. Even if an evolution from preinvasive lesions to an invasive cancer is plausible and coherent with current concepts, this link does not appear strong enough to recommend the use of systematic classic endoscopy for targeting of a sub-group of higher risk smokers who would require a closer follow up.
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Abstract
It has been proposed that invasive carcinoma of the bronchus develops through a transition from preinvasive lesions to overt malignancy. Newer diagnostic technologies have provided a more sensitive way to diagnose preinvasive lesions and a better understanding of the prevalence of such lesions. The natural history of preinvasive lesions has not been well defined; however, there is evidence that high-grade lesions are at a higher risk of progression to carcinoma. Molecular alterations have been described in preinvasive lesions and may help better predict which lesions will progress. Several noninvasive techniques are available for the treatment of high-grade lesions.
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Affiliation(s)
- M Patricia Rivera
- Division of Pulmonary and Critical Care Medicine, Department of Medicine, University of North Carolina at Chapel Hill, 4133 Bioinformatics Building, Mason Farm Road, CB # 7020, Chapel Hill, NC 27516, USA.
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Smoking, occupational risk factors, and bronchial tumor location: a possible impact for lung cancer computed tomography scan screening. J Thorac Oncol 2012; 7:128-36. [PMID: 22031233 DOI: 10.1097/jto.0b013e318233d7a6] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/15/2022]
Abstract
INTRODUCTION The aim of this study was to describe associations between lung tumor location and smoking as well as selected occupational exposures. In the context of lung cancer screening by computed tomography scan, tumor location may have an interest. Computed tomography scan is known to better detect more peripheral tumors. METHODS Lung cancer cases diagnosed in two French University hospitals between 1997 and 2009 were included. Tumors visible on white-light bronchoscopy were defined as central. Occupational exposures were assessed by the same expert. Data were analyzed by case-case comparisons using unconditional logistic regressions. RESULTS A total of 1701 cases were included, comprising mainly men (86.3%), current smokers (52.8%), or former smokers (42.8%). Main histological subtypes of cancer were adenocarcinomas (33.8%) and squamous cell carcinomas (32.6%). The tumor location was found to be central in 61% of cases, and never smokers and women had more often peripheral tumors. Exposure to asbestos was significantly associated with central location with dose-response relationship (odds ratio [OR] for peripheral tumors = 0.45, 95% confidence interval [CI] 0.29-0.70) for the highest level of exposure. Exposure to silica dust was significantly associated with peripheral tumor (OR for peripheral tumors = 3.28, 95%CI 1.50-7.17) for the highest level of exposure. Exposure to welding fumes was associated with central location (OR for peripheral tumors = 0.51, 95% CI 0.26-0.96) for the first level of exposure). CONCLUSIONS Smoking characteristics and occupational exposures have to be considered to define more accurately high-risk populations suitable for lung cancer screening or early detection programs.
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Rahman SMJ, Gonzalez AL, Li M, Seeley EH, Zimmerman LJ, Zhang XJ, Manier ML, Olson SJ, Shah RN, Miller AN, Putnam JB, Miller YE, Franklin WA, Blot WJ, Carbone DP, Shyr Y, Caprioli RM, Massion PP. Lung cancer diagnosis from proteomic analysis of preinvasive lesions. Cancer Res 2011; 71:3009-17. [PMID: 21487035 PMCID: PMC3110721 DOI: 10.1158/0008-5472.can-10-2510] [Citation(s) in RCA: 57] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Early detection may help improve survival from lung cancer. In this study, our goal was to derive and validate a signature from the proteomic analysis of bronchial lesions that could predict the diagnosis of lung cancer. Using previously published studies of bronchial tissues, we selected a signature of nine matrix-assisted laser desorption ionization mass spectrometry (MALDI MS) mass-to-charge ratio features to build a prediction model diagnostic of lung cancer. The model was based on MALDI MS signal intensity (MALDI score) from bronchial tissue specimens from our 2005 published cohort of 51 patients. The performance of the prediction model in identifying lung cancer was tested in an independent cohort of bronchial specimens from 60 patients. The probability of having lung cancer based on the proteomic analysis of the bronchial specimens was characterized by an area under the receiver operating characteristic curve of 0.77 (95% CI 0.66-0.88) in this validation cohort. Eight of the nine features were identified and validated by Western blotting and immunohistochemistry. These results show that proteomic analysis of endobronchial lesions may facilitate the diagnosis of lung cancer and the monitoring of high-risk individuals for lung cancer in surveillance and chemoprevention trials.
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Affiliation(s)
- S M Jamshedur Rahman
- Division of Allergy, Pulmonary and Critical Care Medicine, Department of Medicine, Mass Spectrometry Research Center, Vanderbilt University School of Medicine, Nashville, Tennessee 37232-6838, USA
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[Protocols for lung cancer screening: Limitations, and consequences]. Rev Mal Respir 2010; 27:314-28. [PMID: 20403542 DOI: 10.1016/j.rmr.2009.11.012] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2009] [Accepted: 11/04/2009] [Indexed: 11/23/2022]
Abstract
Lung cancer is the leading cause of cancer mortality in the world. Its incidence is still rising, especially in women, and its prognosis is poor with a 5-year survival of 15%. Since 1970, several studies on lung cancer screening have been conducted using different investigations. Screening by chest X-ray and sputum cytology does not lead to improved survival in lung cancer. Screening by CT scan has the same outcome but the detection of lung cancer, especially in its early stages, is better than with chest X-ray and sputum cytology. Fluorescence endoscopy is a valuable examination for the detection of pre-invasive bronchial lesions. Genetic studies and identification of circulating tumour cells are being developed. All these examinations are very stressful for the patients. Only few trials have studied the consequences of lung cancer screening on the quality of life. In this review, we analyze the various screening strategies, their impact on quality of life and health and their adverse effects.
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Escarguel B, D'Amore D, Chapel F, Bec J, Audigier-Valette C, Lahlah H, Milhe F, Marqueste L. [Early diagnosis of lung cancer: impact of autofluorescence bronchoscopy]. REVUE DE PNEUMOLOGIE CLINIQUE 2009; 65:287-291. [PMID: 19878802 DOI: 10.1016/j.pneumo.2009.04.005] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/30/2008] [Revised: 04/10/2009] [Accepted: 04/20/2009] [Indexed: 05/28/2023]
Abstract
INTRODUCTION Less than 15% of all patients survive five years after a diagnosis of lung cancer. This poor prognosis is attributed to a lack of early detection. Among the methods of early diagnosis of bronchial cancer, autofluorescence bronchoscopy allows for the early identification of preinvasive bronchial lesions. The goal of this prospective study is to evaluate the contribution of the autofluorescence bronchoscopy, on a hospital site, over a period of one year. METHODS All patients with an indication of autofluorescence bronchoscopy were included in the study. The following parameters were collected: age, sex, smoking status, FEV1, FVC, biopsy sites, histology, duration of examination. RESULTS Two hundred and seventy-four patients were included. The average age was 63.8 years (+/-12), the smoking status was 35 packs/year (+/-19). A fluorescence abnormality was detected in 131 patients and 165 sites were biopsied. An histological abnormality was found in 76% of the samples, with 34 hyperplasia (28%), 56 squamous metaplasia (46%), three mild dysplasia (3%), two moderate dysplasia (2%), one severe dysplasia (1%), two carcinomas in situ (2%) and 21 invasive carcinomas (18%). CONCLUSION Autofluorescence bronchoscopy is an effective examination for the detection of the preinvasive neoplasic lesions and may be proposed when lung cancer is suspected.
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Affiliation(s)
- B Escarguel
- Service de Pneumologie, Centre Hospitalier Intercommunal Toulon-La-Seyne, Hôpital Font-Pré, BP 1412, 83056, Toulon Cedex, France.
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Abstract
Preinvasive lesions are considered the precursors of squamous cell carcinoma of the bronchus. Treatment at the preinvasive stage, before the potential for metastasis, may improve survival from squamous cell carcinoma. An understanding of the natural history and outcome of preinvasive lesions is essential for the accurate interpretation studies of their treatment, and decisions regarding the management of individual lesions. The natural history of preinvasive lesions has only been reported in a small number of highly selected patients and uses different inclusion criteria, treatment criteria. and time-periods of follow-up, making it difficult to draw definitive conclusions. High-grade preinvasive lesions carry a risk of progression to carcinoma but most patients have multiple lesions and a significant probability of developing new lesions over time. Distinguishing lesions with malignant potential, the targets for therapy, from those that will regress or remain indolent is difficult. The American College of Chest Physicians guidelines recommend bronchoscopic follow-up of severe dysplasia and carcinoma-in situ. This review of the evidence regarding the natural history and outcome of preinvasive lesions supports this view, but also shows that further studies in individuals at risk for lung cancer are necessary before guidelines for the management of preinvasive lesions can be developed.
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11
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Current indications and future perspective of fluorescence bronchoscopy: A review study. Photodiagnosis Photodyn Ther 2008; 5:238-46. [DOI: 10.1016/j.pdpdt.2009.01.008] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2008] [Revised: 01/27/2009] [Accepted: 01/27/2009] [Indexed: 11/20/2022]
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Stringer MR, Moghissi K, Dixon K. Autofluorescence bronchoscopy in volunteer asymptomatic smokers. Photodiagnosis Photodyn Ther 2008; 5:148-52. [PMID: 19356646 DOI: 10.1016/j.pdpdt.2008.06.002] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2008] [Revised: 06/13/2008] [Accepted: 06/16/2008] [Indexed: 11/24/2022]
Abstract
We assess the sensitivity of autofluorescence bronchoscopy (AFB) compared to that of white light bronchoscopy (WLB) for identification of pre-invasive neoplastic changes of bronchial mucosa in asymptomatic heavy smokers. WLB was performed using a standard flexible fibre-optic bronchoscope, and AFB carried out using the Xillix LIFE Lung((R)) system. Positive AFB images were indicated in the bronchial tree from 51 of the 93 subjects in the study. Biopsies showed epithelial abnormalities in 27 (15 metaplasia, 12 inflammatory changes) of these. WLB showed abnormality in 1 subject but with no pathological changes revealed by cyto-histology. Therefore, the sensitivity of AFB to metaplasia was 75% compared to zero for WLB. AFB yields positive predictive values for metaplastic and overall mucosal changes of 29.4% and 52.9%, respectively. In summary, over 16% of asymptomatic smokers had metaplastic changes in their bronchial mucosa, and AFB proved more sensitive in revealing early changes than WLB.
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Affiliation(s)
- M R Stringer
- Institute of Microwaves and Photonics, School of Electronic and Electrical Engineering, University of Leeds, Woodhouse Lane, Leeds LS29JT, UK.
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Autofluorescence Bronchoscopy to Detect Bronchial Epithelial Changes Associated With Cigarette Smoking Among Asymptomatic Volunteers: A Single Center Prospective Pilot Study. ACTA ACUST UNITED AC 2008. [DOI: 10.1097/lbr.0b013e3181641b5f] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Salaün M, Sesboüé R, Moreno-Swirc S, Metayer J, Bota S, Bourguignon J, Thiberville L. Molecular predictive factors for progression of high-grade preinvasive bronchial lesions. Am J Respir Crit Care Med 2007; 177:880-6. [PMID: 17962638 DOI: 10.1164/rccm.200704-598oc] [Citation(s) in RCA: 38] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
RATIONALE The outcome of precancerous bronchial lesions is not well known, and their management is subject to controversy. Many molecular alterations are present in preinvasive lesions, but none has been assessed to predict the evolution of the lesions. OBJECTIVES To analyze the outcome of high-grade precancerous lesions according to their molecular profile. METHODS Twenty-three severe dysplasia and 31 carcinoma in situ (CIS) lesions in 37 patients were monitored using repeated autofluorescence bronchoscopy over a 12-year period. Microdissection and polymerase chain reaction analysis were performed on paraffin tissue sections to assess loss of heterozygosity (LOH) and microsatellite instability on chromosome 3p, 5q, and 9p. Histology and molecular status at baseline were compared between 7 lesions that became invasive, 11 that relapsed after treatment, 17 that were eradicated with local treatment, and 19 that spontaneously regressed. MEASUREMENTS AND MAIN RESULTS Ninety-four percent of lesions that progressed or relapsed were CIS at baseline, whereas 79% of spontaneously regressing lesions were severe dysplasia (P < 0.0001). 3p and 9p LOH was more frequent in CIS than in severe dysplasia (P = 0.03). In the whole group of lesions as well as in the CIS group, 3p LOH was strongly associated with progression (P < 0.0001 and P = 0.02, respectively). Microsatellite instability was not associated with the outcome of the lesions. A therapeutic strategy based on the presence of 3p or 9p LOH would have led to overtreatment of six lesions but would have missed only 1 among the 18 progressing lesions. CONCLUSIONS Baseline histology and 3p LOH analysis appear to be useful in predicting the outcome of high-grade precancerous lesions.
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Affiliation(s)
- Mathieu Salaün
- Clinique Pneumologique, Hôpital Charles Nicolle-CHU de Rouen, 1 rue de Germont, 76031 Rouen Cedex, France
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Thiberville L, Salaün M, Lachkar S. Les explorations endoscopiques respiratoires en fluorescence. Rev Mal Respir 2007. [DOI: 10.1016/s0761-8425(07)78130-5] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
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16
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Thiberville L, Thibout Y. Autofluorescence : 10 ans d’expérience. Rev Mal Respir 2007. [DOI: 10.1016/s0761-8425(07)91791-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
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Henderson DW, Rödelsperger K, Woitowitz HJ, Leigh J. After Helsinki: a multidisciplinary review of the relationship between asbestos exposure and lung cancer, with emphasis on studies published during 1997-2004. Pathology 2005; 36:517-50. [PMID: 15841689 DOI: 10.1080/00313020400010955] [Citation(s) in RCA: 63] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
Abstract
Despite an extensive literature, the relationship between asbestos exposure and lung cancer remains the subject of controversy, related to the fact that most asbestos-associated lung cancers occur in those who are also cigarette smokers: because smoking represents the strongest identifiable lung cancer risk factor among many others, and lung cancer is not uncommon across industrialised societies, analysis of the combined (synergistic) effects of smoking and asbestos on lung cancer risk is a more complex exercise than the relationship between asbestos inhalation and mesothelioma. As a follow-on from previous reviews of prevailing evidence, this review critically evaluates more recent studies on this relationship--concentrating on those published between 1997 and 2004--including lung cancer to mesothelioma ratios, the interactive effects of cigarette smoke and asbestos in combination, and the cumulative exposure model for lung cancer induction as set forth in The Helsinki Criteria and The AWARD Criteria (as opposed to the asbestosis-->cancer model), together with discussion of differential genetic susceptibility/resistance factors for lung carcinogenesis by both cigarette smoke and asbestos. The authors conclude that: (i) the prevailing evidence strongly supports the cumulative exposure model; (ii) the criteria for probabilistic attribution of lung cancer to mixed asbestos exposures as a consequence of the production and end-use of asbestos-containing products such as insulation and asbestos-cement building materials--as embodied in The Helsinki and AWARD Criteria--conform to, and are further consolidated by, the new evidence discussed in this review; (iii) different attribution criteria (e.g., greater cumulative exposures) are appropriate for chrysotile mining/milling and perhaps for other chrysotile-only exposures, such as friction products manufacture, than for amphibole-only exposures or mixed asbestos exposures; and (iv) emerging evidence on genetic susceptibility/resistance factors for lung cancer risk as a consequence of cigarette smoking, and potentially also asbestos exposure, suggests that genotypic variation may represent an additional confounding factor potentially affecting the strength of association and hence the probability of causal contribution in the individual subject, but at present there is insufficient evidence to draw any meaningful conclusions concerning variation in asbestos-mediated lung cancer risk relative to such resistance/susceptibility factors.
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Affiliation(s)
- Douglas W Henderson
- Department of Anatomical Pathology, Flinders University and Flinders Medical Centre, Bedford Park, Adelaide, South Australia.
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Loewen G, Reid M, Tan D, Klippenstein D, Nava E, Natarajan R, Mahoney M. Bimodality lung cancer screening in high-risk patients: a preliminary report. Chest 2004; 125:163S-4S. [PMID: 15136489 DOI: 10.1378/chest.125.5_suppl.163s-a] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/01/2022] Open
Affiliation(s)
- Gregory Loewen
- Department of Medicine, Roswell Park Cancer Institute, Buffalo, NY 14263, USA.
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Paris C, Benichou J, Thiberville L. Re: Sex-related differences in bronchial epithelial changes associated with tobacco smoking. J Natl Cancer Inst 2003; 95:242-3; author reply 243-4. [PMID: 12569147 DOI: 10.1093/jnci/95.3.242] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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