Role of pleural lavage cytology before resection for primary lung carcinoma.
OBJECTIVE
To investigate the role of pleural lavage cytology (PLC) in resection for primary lung carcinoma.


BACKGROUND
The prognostic significance of PLC before manipulation is still controversial.


METHODS
Cytology of pleural lavage immediately after thoracotomy but before any manipulation of the lung was examined in 500 consecutive patients with lung cancer with no pleural effusion who underwent pulmonary resections. Eighteen patients who already had pleural dissemination were excluded from this study.


RESULTS
Eighteen of 482 patients (3.7%) had positive cytologic findings. The positivity of PLC was significantly correlated with histology, extension of tumor to pleura, and presence of lymphatic permeation or vascular involvement by tumor. Positive lavage findings were seen only in adenocarcinoma. Because 6.3% of the patients with adenocarcinoma had positive cytologic findings, it is vital to perform PLC before curative resections for lung cancer, especially adenocarcinoma. The 5-year survival rates of the patients having negative and positive lavage findings were 52.9% and 14.6%, respectively. The prognosis of the patients with positive lavage findings was as poor as that of the patients with stage IIIB disease and that of the patients with malignant effusion.


CONCLUSIONS
Positive findings on PLC indicate exfoliation of cancer cells into the pleural cavity, which is an essential prognostic factor. In addition, we should regard positive cytologic findings as a subclinical malignant pleural effusion that is pathologic stage T4.
Okada
M
M
Department of Thoracic Surgery, Hyogo Medical Center for Adults, Akashi City, Japan.
Tsubota
N
N
Yoshimura
M
M
Miyamoto
Y
Y
Maniwa
Y
Y
D018893:Bronchoalveolar Lavage; D005260:Female; D006801:Humans; D008175:Lung Neoplasms / Q000401:mortality* / Q000473:pathology* / Q000601:surgery; D008297:Male; D008875:Middle Aged; D009367:Neoplasm Staging; D010994:Pleura / Q000473:pathology*; D011300:Preoperative Care; D011379:Prognosis; D011446:Prospective Studies; D015996:Survival Rate