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Cardiothoracic Surgery |

Clinical Value of Intraoperative Pleural Lavage Cytology in Non-small Cell Lung Cancer Patients

Masatoshi Kakihana*, MD; Jitsuo Usuda, MD; Naohiro Kajiwara, MD; Tatsuo Ohira, MD; Norihiko Ikeda, MD
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Tokyo Medical University, Tokyo, Japan


Chest. 2012;142(4_MeetingAbstracts):58A. doi:10.1378/chest.1389476
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Abstract

SESSION TYPE: Thoracic Surgery Posters I

PRESENTED ON: Wednesday, October 24, 2012 at 01:30 PM - 02:30 PM

PURPOSE: Pleural lavage cytology (PLC) is the microscopic study of cells obtained from saline instilled into and retrieved from the chest cavity. However, this procedure is not necessary for the staging of lung cancer in the current TNM staging system. The aims of this study were to examine whether exfoliated cancer cells can be present in the pleural cavity with no pleural effusion, to determine independence as a prognostic marker and to characterize the impact of a positive result.

METHODS: Between 1995 and 2008, 1965 patients underwent surgical pulmonary resection for primary lung cancer without disseminated disease at our institute. Cytology of pleural lavage immediately after thoracotomy before any manipulation of the lung was examined in 812consecutive patients with lung cancer with no pleural effusion.

RESULTS: The results of the cytologic examination were divided into two categories, positive and negative PLC group. Papanicolaou classes I to IIIa were regarded as negative, classes IIIb, IV and V as positive. Of the 55 patients (6.8%) whose specimens were positive for PLC. Of the 55 patients in the positive PLC group, 47 (8.4%) had adenocarcinoma, with a significantly higher ratio of adenocarcinoma compared with the negative PLC group. Survival in the positive PLC group was significantly worse than in the negative PLC group (p = 0.001), especially in pathologic stage II (p = 0.001). We assume that the PLC positive cases have a T4 status. All PLC positive cases are reassigned Stage III. The result showed almost similar curves was shown between PLC negative Stage III and the adjusted PLC positive Stage III.

CONCLUSIONS: A positive PLC result was a strong unfavorable prognostic factor. PLC should be considered in all patients with early stage lung cancer suitable for resection.

CLINICAL IMPLICATIONS: We propose that positive PLC disease should be managed similarly to dissemination. That suggests it may be appropriate to upstage patients by 1 T category or consider as T4 disease.

DISCLOSURE: The following authors have nothing to disclose: Masatoshi Kakihana, Jitsuo Usuda, Naohiro Kajiwara, Tatsuo Ohira, Norihiko Ikeda

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Tokyo Medical University, Tokyo, Japan

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