DIFFERENTIATING BRONCHIOLOALVEOLAR CARCINOMA FROM ADENOCARCINOMA

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Abstract
The recognition of bronchioiavieolar carcinoma (BAC) as distinct from adenocarcinoma of the lung is controversial. Using strict pathologic criteria, 43 consecutive patients with BAC were matched by year of diagnosis and compared with a similar number of patients with adenocarcinoma, and for contrast with patients with squamous cell and oat cell carcinomas of the lung. BAC was not sex related and was not related to smoking as the other neoplasms were. Unlike epidermoid carcinoma, BAC did not show a predilection for those occupations requiring manual labor. BAC was frequently distinguishable radiologically from the other 3 types being smaller and peripheral. A pleural tag and an air bronchogram in a mass were rather specific, and BAC was less likely to have large airway involvement and adenopathy. The percentage of patients who were free of tumor after 2 yr was greater in the BAC group than in the others, but the overall survival rate between the BAC group and the adenocarcinoma group was not. Based on inter-observer variability, there is some overlap pathologically between these 2 groups. However, when the overlap between the adenocarcinoma and the BAC groups is compared with that between the adenocarcinoma and the squamous cell carcinoma groups,the the difference is not significant. BAC should be considered a distinct clinical entitiy.