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. 2018;95(4):220-227.
doi: 10.1159/000484984. Epub 2018 Feb 12.

Endobronchial Treatment for Bronchial Carcinoid: Patient Selection and Predictors of Outcome

Ellen M B P Reuling  1   2 , Chris Dickhoff  1   3 , Peter W Plaisier  2 , Veerle M H Coupé  4 , Albert H A Mazairac  5 , Rutger J Lely  5 , H Jaap Bonjer  1 , Johannes M A Daniels  6
Affiliations

Endobronchial Treatment for Bronchial Carcinoid: Patient Selection and Predictors of Outcome

Ellen M B P Reuling et al. Respiration. 2018.

Abstract

Background: Traditionally, surgical resection is the preferred treatment for typical carcinoids and atypical carcinoids located in the lungs. Recently however, several studies have shown excellent long-term outcome after endobronchial treatment of carcinoid tumors located in the central airways. This study investigates clinical and radiological features as predictors of successful endobronchial treatment in patients with a bronchial carcinoid tumor.

Objectives: To identify clinical and radiological features predictive of successful endobronchial treatment in patients with bronchial carcinoid.

Methods: This analysis was performed in a cohort of patients with typical and atypical bronchial carcinoid referred for endobronchial treatment. Several patient characteristics, radiological features, and histological grade (typical or atypical carcinoid) were tested as predictors of successful endobronchial treatment.

Results: One hundred and twenty-five patients with a diagnosis of bronchial carcinoid underwent endobronchial treatment. On multivariate analysis, a tumor diameter <15 mm (odds ratio 0.09; 95% confidence interval 0.02-0.5; p = <0.01) and purely intraluminal growth on computer tomography (CT scan) (odds ratio, 9.1; 95% confidence interval 1.8-45.8; p = <0.01) were predictive of radical endobronchial treatment. The success rate for intraluminal tumors with a diameter <20 mm was 72%.

Conclusions: Purely intraluminal disease and tumor diameter on CT scan seem to be independent predictors for successful endobronchial treatment in patients with bronchial carcinoid. Based on these data, patients with purely intraluminal carcinoid tumors with a diameter <20 mm on CT scan are good candidates for endobronchial treatment, regardless of histological grade. In contrast, all patients with a tumor diameter ≥20 mm should be directly referred for surgery.

Keywords: Bronchial carcinoid; Bronchoscopy; Endobronchial treatment; Neuroendocrine tumor; Prognostic factors.

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Figures

Fig. 1
Fig. 1
Treatment of patients with bronchial carcinoid. EBT, endobronchial treatment. * Due to residual or extraluminal disease.
Fig. 2
Fig. 2
Tumor diameter as assessed on initial CT scan in patients with successful and unsuccessful endobronchial treatment (EBT).
Fig. 3
Fig. 3
Suggested treatment protocol of bronchial carcinoid based on assessment of the baseline CT scan. EBT, endobronchial treatment.
See this image and copyright information in PMC

Comment in

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