Radiographic features and prognosis in bronchioloalveolar carcinoma; a local experience

The prognosis of 20 patients with histologically proven bronchioloalveolar carcinoma was assessed in the light of their radiographic features and symptoms at presentation. Radiographically, half the patients were classified as having focal disease of which 60% were focal consolidation. Other focal presentations were, a mass lesion in three cases and a single 3 cm nodule in one case. Those with diffuse disease presented with either coarse widespread nodules or diffuse alveolar opacification with or without a focal area of consolidation. All patients were symptomatic at presentation but the severity of the symptoms bore no relation to the radiological findings. Seven cases with focal disease underwent thoracotomy, five of which had evidence of hilar and mediastinal lymph node involvement. They included a case presenting with a nodule, two with a mass and four with focal consolidation. The survival following surgery was generally better with those with a mass or nodule but one case with focal consolidation remains alive 10.5 years following surgery compared with the longest survivor of 4.5 years with a mass. Both these relatively long-term survivors had no histological evidence of hilar or mediastinal lymph node involvement compared with the other surgical cases. The median survival in cases without surgery was one month. The prognosis was better in patients with focal disease where surgery was performed and we feel that a local area of consolidation should be treated as focal disease and surgical resection considered for these patients.