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J Thorac Cardiovasc Surg 1999;118:702-709
© 1999 Mosby, Inc.

GENERAL THORACIC SURGERY

BRONCHOALVEOLAR CARCINOMA: CLINICAL, RADIOLOGIC, AND PATHOLOGIC FACTORS AND SURVIVAL

From the Thoracic Surgery and Pathology Departments, Massachusetts General Hospital, Boston, Mass.

Address for reprints: Douglas J. Mathisen, MD, Thoracic Surgery, Blake 1570, Massachusetts General Hospital, Fruit St, Boston, MA 02114.

Background: The principal feature of bronchoalveolar carcinoma is that it spreads along airways or aerogenously with multifocality, but many issues are unresolved.
Methods: We studied 119 patients with pathologically confirmed bronchoalveolar carcinoma. Symptoms, smoking status, radiologic findings, the size of tumor, operative procedures, and complications were reviewed. We studied the pathologic features: presence or absence of aerogenous spread, patterns of growth, cell type, nuclear grade, mitosis, rate of bronchoalveolar carcinoma in adenocarcinoma, and lymphocyte infiltration. The correlation among clinical, radiologic, and pathologic findings was examined, and the factors affecting survival were analyzed.
Results: Symptomatic patients had more infiltrative radiographic features, and asymptomatic patients tended to have more mass-like features (P < .0001). Tumors with radiographically infiltrating lesions tended to have mucinous histologic features (P = .006). Tumors with mass lesions by radiograph tended to have nonmucinous and sclerosing histologic features (P = .003). Aerogenous spread was seen in 94% of specimens. The presence of a variety of cell types suggested multiple clonal origin. The overall survival in those patients undergoing resection was 69.1% at 5 years and 56.5% at 10 years. The significant factors affecting survival were radiologic presence of a mass or infiltrate, pathologic findings of the presence of sclerosis, association with a scar, the rate of bronchoalveolar carcinoma in adenocarcinoma, lymphocyte infiltration grade, nodal involvement, and status of complete resection. Mitosis or nuclear grade of tumor cells did not correlate with survival.
Conclusions: Bronchoalveolar carcinoma showed good overall survival with appropriate surgical procedures. Certain radiologic or pathologic findings correlated with survival. These findings may enhance the ability to predict long-term survival.

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