Cell migration leads to spatially distinct but clonally related airway cancer precursors

Christodoulos P Pipinikas, Theodoros S Kiropoulos, Vitor H Teixeira, James M Brown, Aikaterini Varanou, Mary Falzon, Arrigo Capitanio, Steven E Bottoms, Bernadette Carroll, Neal Navani, Frank McCaughan, Jeremy P George, Adam Giangreco, Nicholas A Wright, Stuart A C McDonald, Trevor A Graham, Sam M Janes

Research output: Contribution to journalArticlepeer-review

28 Citations (Scopus)


BACKGROUND: Squamous cell carcinoma of the lung is a common cancer with 95% mortality at 5 years. These cancers arise from preinvasive lesions, which have a natural history of development progressing through increasing severity of dysplasia to carcinoma in situ (CIS), and in some cases, ending in transformation to invasive carcinoma. Synchronous preinvasive lesions identified at autopsy have been previously shown to be clonally related.

METHODS: Using autofluorescence bronchoscopy that allows visual observation of preinvasive lesions within the upper airways, together with molecular profiling of biopsies using gene sequencing and loss-of-heterozygosity analysis from both preinvasive lesions and from intervening normal tissue, we have monitored individual lesions longitudinally and documented their visual, histological and molecular relationship.

RESULTS: We demonstrate that rather than forming a contiguous field of abnormal tissue, clonal CIS lesions can develop at multiple anatomically discrete sites over time. Further, we demonstrate that patients with CIS in the trachea have invariably had previous lesions that have migrated proximally, and in one case, into the other lung over a period of 12 years.

CONCLUSIONS: Molecular information from these unique biopsies provides for the first time evidence that field cancerisation of the upper airways can occur through cell migration rather than via local contiguous cellular expansion as previously thought. Our findings urge a clinical strategy of ablating high-grade premalignant airway lesions with subsequent attentive surveillance for recurrence in the bronchial tree.

Original languageEnglish
Pages (from-to)548-57
Number of pages10
Issue number6
Publication statusPrint publication - Jun 2014
Externally publishedYes

Bibliographical note

Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://group.bmj.com/group/rights-licensing/permissions.


  • Adult
  • Carcinoma in Situ/genetics
  • Carcinoma, Squamous Cell/genetics
  • Cell Movement
  • Genes, p53
  • Humans
  • Loss of Heterozygosity
  • Lung Neoplasms/genetics
  • Male
  • Middle Aged
  • Mutation
  • Neoplasm Invasiveness/genetics
  • Precancerous Conditions/genetics
  • Tracheal Neoplasms/genetics


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