RT Book, Section A1 Savani, Ravi A1 Andoh-Duku, Augustine A1 Demmy, Todd L. A2 Sugarbaker, David J. A2 Bueno, Raphael A2 Burt, Bryan M. A2 Groth, Shawn S. A2 Loor, Gabriel A2 Wolf, Andrea S. A2 Williams, Marcia A2 Adams, Ann SR Print(0) ID 1170411419 T1 Management of Superficial Central Airway Lung Cancers T2 Sugarbaker’s Adult Chest Surgery, 3e YR 2020 FD 2020 PB McGraw-Hill Education PP New York, NY SN 9781260026931 LK accesssurgery.mhmedical.com/content.aspx?aid=1170411419 RD 2024/10/13 AB Squamous cell lung cancer represents between 20% and 30% of all primary lung malignancy.1 It is believed that most squamous cell cancers begin in the central airway and will evolve in a stepwise, predictable way. These cancers are preceded by premalignant lesions that include squamous metaplasia, squamous dysplasia, and carcinoma in situ (CIS). Evidence of premalignant change is detected inconsistently in the induced sputum of high-risk individuals. If the carcinogenesis progresses, eventually central airway tumors will shed malignant cells that can be detected in sputum cytology preparations. Early superficial central airway cancers do not shed malignant cells in a reliable way, and the large-scale lung cancer screening trials of the 1970s and 1980s failed to demonstrate a mortality benefit from lung cancer screening with sputum cytology. Nonetheless, a small percentage of patients were identified with positive sputum cytology despite a normal chest x-ray in these trials. Cancers in this category were termed radiographically occult lung cancers. Although radiographically occult, many of these cancers were found to be early invasive carcinomas, arising from the segmental bronchi with metastases to adjacent lymph nodes. Diagnoses of these lung cancers were confirmed typically with white-light bronchoscopy (WLB).