Diagnosis and treatment of bronchial carcinoid tumors: clinical and pathological review of 120 operated patients.

Clinical and pathological review is presented of 120 patients operated on for bronchial carcinoid tumors between 1976 and 1986. The usual oncologic features were analyzed. The Grimelius reaction, immunohistochemical staining for neuron specific enolase (NSE), serotonin and chromogranin, and DNA-analysis by flow cytometry were performed in these tumors and in small cell lung cancers (SCLC). In our experience the usual oncologic criteria--atypia, tumor-size, localization, history and regional lymph node metastasis--fail to give clear information for the prognosis. The Grimelius reaction has no significant differential diagnostic importance. Immunostaining for NSE can aid in distinguishing between neuroendocrine and non-neuroendocrine pulmonary tumors. The carcinoids and SCLCs could be differentiated by immunostaining for chromogranin and by flow cytometry but none of these methods are suitable for differential diagnosis within the carcinoid group. Resection by thoracotomy is the only treatment of choice: it can provide an excellent result (the 5-year survival rate is above 90%) with a low hospital mortality (0.8%). Parenchyma-sparing resections are to be encouraged.