Bronchiolo-alveolar carcinoma.A reappraisal after 24 years

In the 24-year period since it was first proposed that this lesion arose from the alveolar epithelium in multicentric fashion and, therefore, carried an unfavorable prognosis, a continuing assessment has revealed a spectrum of disease essentially similar to that of other lung cancers. Arising peripherally, localized lesions may have a favorable prognosis, although tumors associated with a hilar adenopathy or those developing in multinodular fashion are of aggressive biologic type. A further series of 74 cases has now been reviewed. All met the specific criteria of primary bronchiolo-alveolar carcinoma, and all have been followed longer than 5 years after diagnosis and treatment. A relatively high proportion proved to be localized, biologically favorable, and amenable to curative treatment by lobectomy. On the basis of this additional experience, it would appear logical to: 1. Consider bronchiolo-alveolar carcinoma a specific entity; 2. Urge prompt treatment of operable disease in an attempt to forestall endo-bronchial or lymphatic spread; 3. Advise lobectomy as the treatment of choice for localized peripheral disease, and 4. Insist that potentially cured patients stop smoking in order to avoid the development of multicentric foci resulting from continuing exposure to external carcinogenic agents.