title: Cytologically malignant margin without continuous pulmonary tumor lesion: cases of wedge resection, segmentectomy and lobectomy.
abstract: The surgical margin is usually investigated during the operation using a pathological method, though cytological methods are also used to identify remaining malignant cells. We reviewed cases of pulmonary resection for a malignant tumor. At our institution, an on-site surgical margin examination using a cytological method is mandated for cases of wedge resection and segmentectomy, and an option in lobectomy cases. We examined 21 wedge resection (3 primary lung cancer, 18 metastasis), 17 segmentectomy (13 primary lung cancer, 4 metastasis), and 4 lobectomy (all primarily lung cancer) cases. Six cases showed malignant cells in the surgical margin, of which one had a microscopic skip lesion pattern and five an 'occult' pattern (positive cytology, negative pathology). Cytological malignancy occurred even in cases of wedge resection of a tiny (4 mm in diameter) lesion metastasized from colon cancer, as well as segmentectomy with a sufficient gross margin containing microscopic skip lesions and right middle lobectomy with an additional right upper lobectomy due to two previous cytological malignancies in a residual lobe. Surgical margin cytology revealed remaining malignancy in the residual lobe, which provided important information for deciding additional procedures during surgery.
authors.affiliation: Department of Cardio-Thoracic Surgery, Dokkyo Medical University School of Medicine, Japan. nsawabata@hotmail.com
authors.forename: Noriyoshi
authors.initials: N
authors.lastname: Sawabata
authors.forename: Youko
authors.initials: Y
authors.lastname: Karube
authors.forename: Hideo
authors.initials: H
authors.lastname: Umezu
authors.forename: Motohiko
authors.initials: M
authors.lastname: Tamura
authors.forename: Norio
authors.initials: N
authors.lastname: Seki
authors.forename: Hiromi
authors.initials: H
authors.lastname: Ishihama
authors.forename: Koichi
authors.initials: K
authors.lastname: Honma
authors.forename: Shinichiro
authors.initials: S
authors.lastname: Miyoshi
mesh_terms: D000328:Adult; D000368:Aged; D003581:Cytodiagnosis; D005260:Female; D006801:Humans; D008175:Lung Neoplasms / Q000473:pathology / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D009362:Neoplasm Metastasis; D009364:Neoplasm Recurrence, Local / Q000473:pathology / Q000517:prevention & control*; D018365:Neoplasm, Residual / Q000473:pathology* / Q000628:therapy; D011013:Pneumonectomy; D013510:Pulmonary Surgical Procedures / Q000379:methods*; D012189:Retrospective Studies; D020775:Thoracic Surgery, Video-Assisted