Carcinoma in situ and early invasive carcinoma of the bronchus.

Ten patients are described who underwent lobectomy or pneumonectomy and were shown to have a bronchial carcinoma in situ or early invasive carcinoma. The diagnosis was generally made only by histological examination following resection. The lesions were all squamous in type. It is probably uncommon for such lesions to be multifocal at any one time and following removal they carry a good prognosis. However, we think that these patients have a much increased chance of subsequently developing further squamous bronchial carcinomas in the remaining lung tissue, and so a prolonged follow-up over many years is desirable. In our series, these early lesions were present in only 2·0% of all resections for lung cancer. A group of patients with such early tumours present with disproportionately severe radiographic changes, as there is a papillary lesion producing bronchial obstruction, and so the lesion appears clinically to be more advanced than it really is. A pre-operative diagnosis of carcinoma in situ is more likely in the other group of patients without obstruction, who are heavy smokers, are chronic bronchitics, and are having repeated small haemoptyses. This group presents a problem in management and requires careful observation. Investigations for finding early lesions include regular cytological examination of the sputum, followed by bronchoscopy in an attempt to localize the lesion if cytology is positive. Lobectomy or pneumonectomy should be undertaken when the site is established.