JR v.early Detection of Central Airway Lung Cancer in Smokers With Silicosis

7/30/2019 JR v.early Detection of Central Airway Lung Cancer in Smokers With Silicosis

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Supervisor :

Dr. Pandiaman Pandia Sp.P(K)

JURNAL READING VI

Early detection of central airway lung cancer in smokers with silicosisA.L.L. Lo, Y. Huang, S.Y. Lam, A.H.K. Cheung, R.Au, C. C. Leung, W. K. Lam, M. S. M. Lp, M. Chan-Yeung,B.Lam

dr.MohammadRamadhaniSoeroso


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MATERIALS AND METHODS

From June 2006 to March 2009, all patients

followed up at the designated

Pneumoconiosis Clinic of Hong Kong were

invited to join the study if they fulfilled the

following inclusion criteria: 1) age 40 years;

2) smoking history of20 pack-years; and 3)

confirmed diagnosis of silicosis. The

diagnosis of silicosis was based on significant

occupational exposure to silica-containingdust and radiographic changes consistent

with silicosis, with or without histological

proof.


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Subjects were asked to provide early morning

sputum for 3 consecutive days. All fresh specimens

were examined by trained cytotechnologists underthe supervision of a pathologist (SYL) in the

Cytology Laboratory of the Department of Health.

The results were reported as unsatisfactory,

normal, atypia, suspicious for cancer and cancer.all sputum samples were sent for cytometry

examination using an automated high-resolution

image cytometer.

SPUTUM

EXAMINATION


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Was performed under local anaesthesia

in the endoscopy suite. ConventionalWLB was performed first, followed by

autoflourescence bronchoscopy. All

abnormal sites were videotaped,recorded, and biopsied.

BRONCHOSCOPY


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Standard spirometry was performedbefore bronchoscopy. FEV1 & FVC

were measured and expressed as a

percentage of the predicted value based

on a prediction equation for the Chinesepopulation. Airflow limitation was defined

as a ratio of FEV1 to FVC of


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MANAGEMENT

Subjects with intraepitheliel lung cancer(severe

dysplasia and CIS) were treated with endobrochial

cryotherapy and reassesed periodically with WLB and

autoflourescence bronchoscopy every 3, 6, 12, and 24

months. Subjects with pre-neoplastic lesions(squamousmetaplasia and dysplasia) were followed up with WLB

and autoflourescence bronchoscopy every 6 months

until the lesion regressed. All abnormal sites detected

and sites that received treatment were biopsied at re-assessment. Physicians advice for smoking cessation

were given to all participants in the study.


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OUT COME

The outcome of this cohort,

including the number of

patients with lung cancer andthe stage distribution, was

determined from patient

records reviewed in July

2009.


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ETHICAL CONSIDERATIONS

Ethical approval was

obtained from institutional

review board of both theDepartment of Health and the

University of Hong Kong.

Informed consent was obtainedfrom each subject.


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STATISTICAL ANALYSIS

Subjects were divided into 2 groups for analyses.

Group 1 includes patients with endobronchial

biospy revealing squamous metaplasia or above.

Group 2 are those without endobronchial lesion orbiopsy showing hyperplasia or below. Continous

data were expressed as mean standard

deviation(SD) and categorical data were

presented as percentage. Fishers exact test andthe 2 independent sample t-tests were used to

compare dichotomous and continuous data

between the 2 groups.


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RESULTS

From June 2006 to March 2009, we screened 720subjects with silicosis. A final total of 48 eligibleChinese male subjects with sputum abnormalitieswere recruited into the study. The mean age of thiscohort was 63 10 years (range 4882), with an

accumulated smoking history of 51 30 pack-years.


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DISCUSSION

Squamous cell carcinoma develops in agradual and stepwise fashion therefore if thepre-cancerous and pre-invasive lesions can be

detected in eary stages and treated, thedevelopment of lung cancer may be arrested.

Combination of sputum cytology/ cytometryand autofluorescencebronchoscopy as a

screening tool, shows 4.2% of the silicoticpatients with sputum abnormality hadintraepithelial (Stage 0) lung cancer.


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DISCUSSIONIn our cohort, squamous metaplasia and mildto moderate dysplasia were detected in 29.2%of the subjects and up to 9% of patientsprogress to intraepithelial lung cancer with a

median follow-up of 21 months. Subjectsharbouring these lesions should also thereforebe followed up.

Current smoking and a history of asbestosexposure were associated with an increased

risk of such lesions. The findings suggest thatautofluorescencebronchoscopy is essential forsilicotic patients presenting with sputumabnormalities.


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CONCLUSION

Sputum examination followed by

autoflourescence bronchoscopy

may be a useful way of identifyingcancerous/pre cancerous lesions

among silicotic smokers. Current

smoking and asbestos exposure

were associated with this lesions.


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JR v.early Detection of Central Airway Lung Cancer in Smokers With Silicosis

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