BACKGROUND: The purpose of this study was to look at the clinical behavior of
bronchial carcinoids and clarify a
surgical approach. METHODS: Eighty-four patients resected for
bronchial carcinoids were retrospectively reviewed for clinicopathologic variables,
surgical management, and outcome.
Tumors were considered "typical" or "atypical" based on
histologic features. "Conservative"
surgery signified
lung parenchyma-sparing procedures.
Survival analysis was performed using standard
statistical methods. RESULTS: Most patients presented with an abnormal routine
chest x-ray. One patient had the
carcinoid syndrome.
Computed tomography scan reliably predicted
lymph node status and bronchoscopic
biopsy diagnosed
carcinoids with 70% success. Fifteen "conservative" procedures were performed. Fifteen percent of patients had atypical
carcinoids, 12% presented with
lymph node metastases, and 6 patients had tumorlets associated with the
primary tumor. Overall survival rates were 93% and 82% at 5 and 10 years, respectively. Significantly decreased disease-free survival was found with atypical
histology (p < 0.0001) and the presence of tumorlets (p = 0.02);
lymph node involvement strongly tended toward poorer outcome. CONCLUSIONS:
Bronchial carcinoids have a definite
malignant potential predicted by atypical
histology, presence of tumorlets, and
lymph node involvement. These features can be identified with routine bronchoscopic
biopsy,
computed tomography scanning, and intraoperative assessment including
frozen section. In the select group of patients without negative features, strong consideration should be given to performing a conservative resection.
