Mason M K, Jordan J W
Thorax. 1969 Jul;24(4):461-71. doi: 10.1136/thx.24.4.461.
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.
本文描述了10例接受肺叶切除术或全肺切除术的患者，术后病理显示为原位支气管癌或早期浸润性癌。通常只有在切除术后通过组织学检查才能做出诊断。所有病变均为鳞状细胞癌。此类病变在同一时间多灶性出现的情况可能并不常见，切除后预后良好。然而，我们认为这些患者在剩余肺组织中随后发生进一步鳞状支气管癌的几率会大大增加，因此需要进行多年的长期随访。在我们的系列研究中，这些早期病变仅占所有肺癌切除术的2.0%。一组患有此类早期肿瘤的患者影像学改变异常严重，因为存在产生支气管阻塞的乳头状病变，所以从临床来看，病变似乎比实际情况更严重。另一组无阻塞症状、重度吸烟、患有慢性支气管炎且反复出现少量咯血的患者更有可能术前诊断为原位癌。这组患者在管理上存在问题，需要密切观察。发现早期病变的检查包括定期进行痰细胞学检查，如果细胞学检查呈阳性，则进行支气管镜检查以试图定位病变。确定病变部位后应进行肺叶切除术或全肺切除术。
