Douglas E. Sanders

Bronchiolo-alveolar carcinoma. A reappraisal after 24 years

In the 24‐year period since it was first proposed that this lesion arose from the alveolar epithelium in multicentric fashion and, therefore, carried an unfavorable prognosis, a continuing assessment has revealed a spectrum of disease essentially similar to that of other lung cancers. Arising peripherally, localized lesions may have a favorable prognosis, although tumors associated with a hilar adenopathy or those developing in multinodular fashion are of aggressive biologic type. A further series of 74 cases has now been reviewed. All met the specific criteria of primary bronchiolo‐alveolar carcinoma, and all have been followed longer than 5 years after diagnosis and treatment. A relatively high proportion proved to be localized, biologically favorable, and amenable to curative treatment by lobectomy. On the basis of this additional experience, it would appear logical to: 1. Consider bronchiolo‐alveolar carcinoma a specific entity; 2. Urge prompt treatment of operable disease in an attempt to forestall endo‐bronchial or lymphatic spread; 3. Advise lobectomy as the treatment of choice for localized peripheral disease, and 4. Insist that potentially cured patients stop smoking in order to avoid the development of multicentric foci resulting from continuing exposure to external carcinogenic agents.

Intrathoracic manifestations of amyloid disease.

Nine cases of intrathoracic amyloid disease have been reviewed. A brief summary of historical material is presented along with detailed descriptions of the more pertinent cases. Observations suggest that a classification of the radiographic manifestations is needed with stress on massive calcific lymph node enlargement and a pulmonary lesion characterized by aggregations of small nodules.

Cytologic diagnosis of bronchioloalveolar carcinoma by fine-needle aspiration biopsy

From 1970 to June 1984, 275 patients with bronchioloalveolar carcinoma were admitted to the Toronto General Hospital. Of these, 181 (190 aspiration biopsies, including nine repeat samples) had this diagnosis made following the use of transthoracic fine‐needle aspiration biopsy. Based on the cytomorphologic features observed in the aspiration preparations, the tumor was subclassified into three types: nonsecretory, secretory, and poorly differentiated. The cytologic features of these three types of bronchioloalveolar carcinoma are presented and illustrated. Cytomorphologically, the three types of this tumor are distinctly different and their features are sufficiently distinctive from those of bronchogenic adenocarcinoma and metastatic adenocarcinomas to be of diagnostic value. Transthoracic fine‐needle aspiration biopsy appears to be a definitive minimally invasive means of establishing the diagnosis of bronchioloalveolar carcinoma preoperatively and especially to be of value for those small peripheral cancers which are relatively inaccessible to direct method of study and are potentially surgically curable. Cancer 57:1565–1570, 1986.

Complementary value of pulmonary angiography and mediastinoscopy in individualizing treatment for patients with lung cancer

Pulmonary angiography and mediastinoscopy were studied as complementary methods of obtaining information for an individualized treatment program for bronchogenic carcinoma, each case being treated according to assessment of the biological nature of the tumor and the technical feasibility of resection. Mediastinoscopy was used primarily for the biological determination and angiography for the determination of technical feasibility. A series of 371 patients with bronchogenic carcinoma had single preoperative angiograms; 199 of them had complementary mediastinoscopy. Findings confirm the indication from earlier work that the development of reliable methods to permit the technical and biological definition of potential resectability has resulted in a fall in the nonresectability rates. Mediastinoscopy, particularly when combined with angiography, is the most efficient method presently available for accurate assessment of resectability. When both procedures are negative, resection is accomplished in 97 of every 100 cases in which thoracotomy is performed at the present time.