Original ArticlesPrognostic value of positive pleural lavage in patients with lung cancer resection
Section snippets
Material and methods
Between March 1995 and December 1997, 137 patients underwent pleural lavage during thoracotomy for potentially curative resection of lung cancer at Fox Chase Cancer Center. Patients with evidence of pleural fluid on posteroanterior or lateral chest roentgenogram were excluded from this study. Immediately after opening the pleura, 250 mL of warm Ringer’s lactate solution was instilled into the pleural space. The patient was gently rocked to assure thorough distribution. The fluid was then
Results
Table 1describes patient sex, age, procedure performed, histology, and stage.
A total of 107 (82%) of the 130 patients had negative preoperative and postoperative lavage cytology results. Of the 17 patients with positive preoperative cytology findings, 8 (47%) also had a positive postoperative lavage result. Among the 14 patients with positive cytology findings after resection, 8 (57%) had a positive preoperative lavage sample.
Comment
Cancer cells identified in a preoperative lavage in patients without a pleural effusion are evidence of micrometastatic disease. The outcome of these patients after standard surgical resection has not been established. Thus, it is unclear exactly where they fit into the staging system.
The first report on pleural cavity cytology was in 1958 by Spjut and associates [8]. They demonstrated a 46% positive pleural cytology findings (obtained after resection), but they did not analyze the patients for
Acknowledgements
Grateful acknowledgment is given to Melyvn Goldberg, MD, for performing pleural lavage on the patients he resected for lung cancer.
References (9)
- et al.
Prognostic significance of pleural lavage cytology immediately after thoracotomy in patients with lung cancer
J Thorac Cardiovasc Surg
(1993) - et al.
Pleural cytologies in lung cancer without pleural effusions
Ann Thorac Surg
(1997) The malignant pleural effusiona review of cytopathologic diagnoses of 584 specimens from 472 consecutive patients
Cancer
(1985)- et al.
Primary carcinoma of the lunga review of 417 histologically proved cases
Dis Chest
(1966)
Cited by (45)
The Impact of Pleural Lavage Cytology Both before and after Lung Resection on Recurrence of Non-Small Cell Lung Cancer
2016, Annals of Thoracic SurgeryCitation Excerpt :Kotoulas and associates [6] reported that post-PLC positive status was an important prognostic factor. Dresler and associates [7] concluded that positive post-PLC status was significantly associated with worse survival. Enatsu and associates [8] reported that post-PLC status had a greater and independent impact on survival than pre-PLC status [8].
Prognostic value of intraoperative pleural lavage cytology for non-small cell lung cancer: The influence of positive pleural lavage cytology results on T classification
2014, Journal of Thoracic and Cardiovascular SurgeryPleural lavage cytology: Where do we standα
2014, Lung CancerCitation Excerpt :In that same study by Nakagawa et al., the pre-resectional PLC status was demonstrated to be an independent prognostic factor (P = 0.016), along with pleural invasion. The impact of a positive pre-resectional PLC on prognosis is much more apparent in early rather than advanced stages of lung cancer, presumably because the prognosis of advanced stages being so poor, a negative impact of a positive PLC is difficult to detect [13,21]. In other words, the more advanced the tumor, the higher the incidence of positive PLC, and the less the new prognostic information acquired [9].
Impact of positive pleural lavage cytology on survival in patients having lung resection for non-small-cell lung cancer: An international individual patient data meta-analysis
2010, Journal of Thoracic and Cardiovascular SurgeryThe impact on survival of positive intraoperative pleural lavage cytology in patients with non-small-cell lung cancer
2010, Journal of Thoracic and Cardiovascular Surgery