Author of

• 13580

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  P1.04 - Poster Session/ Biology, Pathology, and Molecular Testing (ID 233)

  • Event: WCLC 2015
  • Type: Poster
  • Track: Biology, Pathology, and Molecular Testing
  • Presentations: 1
  • Moderators:
  • Coordinates: 9/07/2015, 09:30 - 17:00, Exhibit Hall (Hall B+C)

  • 13610

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    P1.04-030 - Intra-Operative Pleural Lavage Cytology after Thoracotomy for Lung Cancer (ID 2906)

    09:30 - 09:30  |  Author(s): K. Nawa
    • Abstract

    Background:
    Pleural lavage cytology (PLC) is the microscopic study of cells obtained from saline instilled into and retrieved from the chest cavity (in patients without preoperative pleural effusion) during surgery for non–small-cell lung cancer. The solution is aspirated, and cytologic analysis is performed to screen for malignant cells. Results from this procedure have been published from Japan as early as 1989,1 and internationally, an increasing number of centers have adopted this practice.
    
    Methods:
    Between 1995 and 2013, 2616 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 1563consecutive patients with lung cancer with no pleural effusion. The macroscopic status of the pleural cavity was evaluated before any manipulation, and when no malignant findings were noted, the pleural cavity was washed with 100 ml of physiologic saline solution.
    
    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 83 patients (6.8%) whose specimens were positive for PLC. Of the 83 patients in the positive PLC group, 74 (4.7%) 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. We propose that positive PLC positive disease should be classified to pathologic T4 and managed similarly to dissemination.
    
    Conclusion:
    A positive PLC result was a strong unfavorable prognostic factor, and almost all patients with positive PLC relapsed within 5 years. PLC should be considered in all patients with early stage lung cancer suitable for resection ,especially, done when assessing the final stage in patients with adenocarcinoma of the lung. A positive result is an independent predictor of adverse survival and carries a prognosis. That suggests it may be appropriate to upstage patients by 1 T category or consider as T4 disease.