Early Invasive Carcinoma Occurring in the Tracheobronchial Trees in Cases of Bronchial Carcinoma

Our plain-English summary of Early Invasive Carcinoma Occurring in the Tracheobronchial Trees in Cases of Bronchial Carcinoma, by O. Auerbach, J.B. Gere, J.M. Pawlowski, et al (1957).

The study

• Authors: O. Auerbach, J.B. Gere, J.M. Pawlowski, G.E. Muehsam, H.J. Smolin, A.P. Stout
• Published: Journal of Thoracic Surgery, Volume 34 No3. September 1957.
• 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 1957 autopsy study examined the airways (tracheobronchial tree) of 54 white men who died with bronchogenic carcinoma (lung cancer). Fifty-three were autopsied at the VA Hospital in East Orange, New Jersey, and one at the VA Hospital in Albany, New York. Asbestos is not mentioned; smoking histories are reported. Three pathologists examined 7,993 usable slides for carcinoma-in-situ, an early cancer change confined to the airway lining. Definite carcinoma-in-situ appeared on 735 slides (9.2 per cent) and borderline changes on 622 (7.8 per cent), together 1,357 (17.0 per cent). Forty-eight of the 54 men showed some change. Similar rates were found in the lung opposite the main tumor and across the airway divisions. Definite or borderline early invasive carcinoma was found in 5 of the 54 cases; in 2 of these, the only affected slide was borderline. The authors concluded that early invasion near carcinoma-in-situ suggests carcinoma-in-situ is a stage prior to invasion, and that its widespread distribution offers, in part, an explanation for the low cure rate. They said the eventual fate of these foci needs much more study.

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: Autopsy study with systematic serial microscopic examination of the tracheobronchial tree; each slide was read by three pathologists
• Who was studied: 54 white men who had frank bronchogenic carcinoma at autopsy: 53 from the Veterans Administration Hospital, East Orange, N.J., and 1 from the VA Hospital, Albany, N.Y. Ages ranged from 32 to 84 years, and 39 (72.0 per cent) were aged 50 to 69. Tumor types were 33 squamous-cell, 16 undifferentiated, 3 alveolar cell and 2 malignant cylindroma.
• Exposure: No asbestos exposure is discussed. Smoking histories: 47 regular cigarette smokers, 1 occasional cigarette smoker, 4 ex-cigarette smokers, and 2 who smoked only cigars or pipes.
• Main results:
  • 48 of the 54 cases showed some change
  • Definite carcinoma-in-situ was present in 735 (9.2 per cent) of the 7,993 usable slides
  • Borderline carcinoma-in-situ was present in 622 (7.8 per cent) of the slides
  • Definite and borderline carcinoma-in-situ together were present in 1,357 (17.0 per cent) of the slides
  • Among the 48 cases with changes, the share of slides with definite or borderline carcinoma-in-situ ranged from 0.5 to 59.9 per cent per case
  • In the lung opposite the main tumor (51 cases analysed), 43 cases showed some changes
  • In the opposite lung, definite carcinoma-in-situ was present in 420 (9.8 per cent) of 4,287 usable slides
  • In the opposite lung, borderline carcinoma-in-situ was present in 381 (8.9 per cent) slides
  • In the opposite lung, definite and borderline carcinoma-in-situ together were present in 801 (18.7 per cent) slides
  • There was no significant difference in the percentage of slides with findings across the anatomic divisions of the airways (for example 14.9 per cent in the trachea and 20.1 per cent in the right main bronchus). The authors attributed the differences to sampling variation.
  • Early invasive carcinoma (borderline or definite) was found in 5 cases, on a total of 35 slides: one slide in each of 2 cases (classed as borderline invasion), and 4, 9 and 20 slides in the other 3 cases
  • In 2 of these cases, foci of early invasion were present in both lungs, and in 9 instances the changes were in contiguous areas a minimum of 4.0 mm apart
• The authors' conclusion: The authors concluded that the presence of early invasive carcinoma in the region of carcinoma-in-situ suggests that carcinoma-in-situ is a stage prior to invasion. They also concluded that the widespread distribution of these findings offers, in part, an explanation for the low cure rate.
• Limitations the authors state:
  • In 3 cases it was not possible to tell which lung was mainly involved by the tumor, and these cases were excluded from the opposite-lung analysis
  • The ultimate fate of the carcinoma-in-situ foci was unknown and, in the authors' words, will require much study
  • In most instances the lesions could not be recognized by their gross appearance, so microscopic diagnosis was essential
  • The study did not explain why primary tracheal carcinoma is rare even though carcinoma-in-situ was seen about as often in the trachea as elsewhere

Topics

Medical terms in this study, explained in our Lexicon: Carcinoma, Autopsy, Bronchogenic Carcinoma, Lung Cancer.

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