Classification of Lung Cancer

Our plain-English summary of Classification of Lung Cancer, by D.T. Carr, J.M. Lukeman (1980).

The study

• Authors: D.T. Carr, J.M. Lukeman
• Published: The Cancer Bulletin, Volume 32 No3. (1980)
• Type of article: Journal article
• Our copy: from Johns-Manville's own medical library. The article is still under copyright, so we describe it here rather than post it.

In plain English

This article was a narrative review by two physicians at M. D. Anderson Hospital in Houston. It described how lung cancer is classified by cell type and staged by how far it has spread. It did not study asbestos or any other exposure. The authors described a cell-type classification used by the Lung Cancer Study Group and their hospital, a modified form of earlier World Health Organization and Working Party schemes. They reported that pathologists at six medical centers using it achieved 93% reproducibility of diagnosis on surgically removed lung specimens. They wrote that small bronchoscopic biopsies showed crushed tissue in 20% to 25% or more of cases, which could lead to the wrong cell type being diagnosed. Citing published experience, they stated that a series of sputum samples detected lung cancer in 70% or more of patients. They reported that needle aspiration biopsy was valid in about 87% of cases in their hospital's series. They also described the TNM staging system of the American Joint Committee's Task Force. The authors concluded that each lung cancer patient should be accurately and completely classified.

We wrote this plain-English summary from the full article with the help of AI, and a second AI model checked each sentence against the article. It is not the authors' wording; the abstract and the article are their own account.

What the study did and found

• Design: Narrative review and educational article on the histologic classification, cytologic diagnosis and staging of lung cancer
• Main results:
  • The authors reported that pathologists working at six medical centers using the modified classification achieved 93% reproducibility of diagnosis on surgically resected lung specimens.
  • The authors stated that a crushed appearance was observed in 20% to 25% or more of small bronchoscopic biopsies. This appearance was long taken as a sign of small (oat) cell carcinoma, but on final review the tissue was often another tumor.
  • Citing published experience, the authors stated that a series of sputum samples (three consecutive early-morning cough specimens) is valuable for detecting lung cancer in 70% or more of patients.
  • Diagnosis by needle aspiration biopsy of peripheral lesions 1 cm in diameter or larger was reported to be valid in approximately 87% of cases in the M. D. Anderson Hospital series.
  • A Task Force statement quoted by the authors reported that one group of 15 patients was staged independently by 26 physicians and research assistants with more than 90% consistency.
  • The authors wrote that more recent studies suggest survival in small cell lung cancer is more significantly related to stage than older data showed, and that small cell lung cancers should therefore be staged.
• The authors' conclusion: The authors concluded that each patient with lung cancer should be accurately and completely classified, for better management, communication about individual patients, and scientific reporting on groups of patients.
• Limitations the authors state:
  • The authors stated that space did not permit presentation of the many variants of these tumors.
  • The authors stated that the histologic and cytologic descriptions were brief.
  • The authors noted that the survival data shown for small cell lung cancer were accumulated more than ten years earlier.

Topics

Medical terms in this study, explained in our Lexicon: Lung Cancer, Sputum, Biopsy, TNM Staging.

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