Cell type in the choice of cases of carcinoma of the bronchus for surgery.

Since it is usually accepted that the more anaplastic bronchial carcinomas have a worse outlook, it might be thought that the type of cell found in a positive biopsy from bronchoscopy would give a clear lead as to prognosis. Indeed, Nicholson, Fox, and Bryce (1957) stated that the prognosis was best for squamous-celled growths and almost hopeless for spheroidal-celled, oatcelled, and anaplastic tumours. However, figures of five years' survival after resection published in this country and in the U.S.A. do not entirely support this view (Table I). Some authors have excluded those patients who did not long survive operation, and one paper reported only lobectomy as opposed to pneumonectomy. These variations should not invalidate comparison of the groups. There is general agreement that excluding bronchial adenomas the cases fall into three broad groups: (1) squamous (epidermoid); (2) anaplastic (undifferentiated, including oat-celled); and (3) adenocarcinoma, which usually includes the very rare alveolar-celled type. Some authors (Kirklin, McDonald, Clagett, Moersch, and Gage, 1955) have pointed out that the anaplastic group can be divided into smalland large-celled types and that the former have a particularly bad prognosis. Table I shows that the outlook for the anaplastic group is indeed a little worse than that for the squamous type, but the difference is not great and