Preoperative bronchoscopic cancer confirmation does not increase risk of recurrence in stage1A non-small cell lung cancer

  • Jiro Abe
  • Toshimasa Okazaki
  • Naohiko Kikuchi
  • Satomi Takahashi
  • Akira Sakurada
  • Yoshinori Okada
Original Article



This study was conducted to evaluate the risk of recurrence possibly caused by preoperative bronchoscopic cancer confirmation in stage1A non-small cell lung cancer.


One hundred and seventy-nine cases of peripheral non-small cell lung cancer (including 151 adenocarcinoma) with no more than 3 cm in their tumor longer diameter were selected. All patients underwent preoperative diagnostic bronchoscopy followed by lobectomy, and were demonstrated to have pathologically free of lymph node involvement and pleural involvement. Radiological and pathological low-grade adenocarcinomas were excluded. Of 179 cases, 95 were confirmed lung cancer by bronchoscope (Group 1) and rest 84 had failed cancer confirmation by bronchoscope before surgery (Group 2). Forty-eight pairs for non-small cell lung cancer and 41 pairs for adenocarcinoma were identified from each group by propensity caliper matching. Kaplan–Meier method and log-rank test were performed on matched groups, and Cox proportional hazard model analysis was performed on whole matched cases.


Log-rank test revealed no significant inferiority of recurrence-free survival of Group 1 in both all-NSCLC and adenocarcinoma subset. Cox proportional hazard model analysis also revealed that the ‘presence of preoperative bronchoscopic cancer confirmation’ dose not increase risk of recurrence in both NSCLC and adenocarcinoma subset.


It is unlikely that preoperative bronchoscopic cancer confirmation would increase recurrence risk in stage1A non-small cell lung cancer; however, a future prospective study with larger cohorts would be warranted to validate the results.


Bronchoscope Diagnosis Lung adenocarcinoma Prognostic factor 



Confidence interval


Endobronchial ultrasonography-guide sheath


Hazard ratio


High-resolution computed tomography


Left lower lobe


Left upper lobe


Non-small cell lung cancer


Recurrence-free survival


Right lower lobe


Right middle lobe


Right upper lobe


Transbronchial biopsy



For this publication, each author had engaged in the work as follows; Jiro Abe designed the study structure, collected patients’ data, analyzed data, and wrote the article; Toshimasa Okazaki collected patients’ data; Naohiko Kikuchi collected patients’ data; Satomi Takahashi collected patients’ data; Akira Sakurada advised regarding statistical issue; Yoshinori Okada supervised the whole work.

Compliance with ethical standards

Conflict of interest

The authors have declared that no conflict of interest exists.


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Copyright information

© The Japanese Association for Thoracic Surgery 2018

Authors and Affiliations

  1. 1.Department of Thoracic SurgeryMiyagi Cancer CenterNatoriJapan
  2. 2.Department of Thoracic Surgery, Graduate School of MedicineTohoku UniversitySendaiJapan

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