Objectives: We recently developed pleural lavage cytology for lung cancer patients without intraoperative signs of malignant pleuritis (Ann Surg Oncol, 4: 409, 1997). We analyzed recurrent patterns in pleural lavage cytology-positive lung cancer patients without intraoperative signs of malignant pleuritis based on semiquantitative evaluation of tumor cell clusters in pleural lavage solution.Methods: Between December 1987 and December 1998, pleural lavage cytology-positive results after thoracotomy were obtained in 97 cases of lung cancer despite the lack of evidence of malignant pleuritis. Based on semiquantitative evaluation of the mean number of tumor cell clusters per slide in pleural lavage solution, patients were classified as Type I, in whom the mean number of clusters was < 1; Type II, in whom clusters numbered 1–10; and Type III, in whom clusters exceeded 10.Results: Type I patients numbered 37, Type II 40, and Type III 20. By September 1999, pleural recurrence had occurred in 17 patients (18%)—2(5%) Type I, 4 (10%) Type II, and 11 (55%) Type III. The incidence of pleural recurrence was significantly higher for Type III patients, i.e., 5 of 11 Type III patients with pleural recurrence showed no sign of distant metastasis. In contrast, the main recurrent patterns in the other 2 groups were extrathoracic, nodal, and/or intrapulmonary.Conclusions: The semiquantitative evaluation of tumor cell clusters in pleural lavage cytology-positive patients provided useful information on postoperative recurrence. Since Type III patients are at high-risk for pleural recurrence, postoperative therapy targeting local control should be conducted in such patients.
This is a preview of subscription content, log in to check access.
Buy single article
Instant access to the full article PDF.
Price includes VAT for USA
Subscribe to journal
Immediate online access to all issues from 2019. Subscription will auto renew annually.
This is the net price. Taxes to be calculated in checkout.
Japan Lung Cancer Society. TNM classification. General Rules for Clinical and Pathological Records of Lung Cancer (4th Edition). Tokyo: Kanehara, 1995: 74–121.
Mountain CF. Revision in the international system for staging lung cancer. Chest 1997; 111: 1710–7.
Kodama K, Doi O, Tatsuta M, Kuriyama K, Tateishi R. Development of postoperative intrathoracic chemothermotherapy for lung cancer with objective of improving local cure. Cancer 1989; 64: 1422–8.
Kodama K, Doi O, Higashiyama M, Yokouchi H, Tatsuta M. Long-term results of postoperative intrathoracic chemothermotherapy for lung cancer with pleural dissemination. Cancer 1993; 72: 426–31.
Eagan RT, Bernatz PE, Payne WS, Pairolero PC, Williams DE, Goellner JR, et al. Pleural lavage after pulmonary resection for bronchogenic carcinoma. J Thorac Cardiovasc Surg 1984; 88: 1000–3.
Buhr J, Berghauser K-H, Morr H, Dobroschke J, Ebner HJ. Tumor cells in intraoperative pleural lavage. An indication for the poor prognosis of bronchogenic carcinoma. Cancer 1990; 65: 1801–4.
Okumura M, Ohshima S, Kotake Y, Morino H, Kikui M, Yasumitsu T. Intraoperative pleural lavage cytology in lung cancer patients. Ann Thorac Surg 1991; 51: 599–604.
Kondo H, Asamura H, Suemasu K, Goya T, Tsuchiya R, Naruke T, et al. Prognostic significance of pleural lavage cytology immediately after thoracotomy in patients with lung cancer. J Thorac Cardiovasc Surg 1993; 106: 1092–7.
Higashiyama M, Doi O, Kodama K, Yokouchi H, Tateishi R, Horai T et al. Pleural lavage cytology immediately after thoracotomy and before closure of the thoracic cavity for lung cancer without pleural effusion and dissemination: clinicopathological and prognostic analysis. Ann Surg Oncol 1997; 4: 409–15.
Buhr J, Berghauser KH, Gonner S, Kelm C, Burkhardt EA, Padberg WM. The prognostic significance of tumor cell detection in intraoperative pleural lavage and lung tissue cultures for patients with lung cancer. J Thorac Cardiovasc Surg 1997; 113: 683–90.
Hillerdal G, Dernevik L, Almgren S-O, Kling P-A, Gustafsson G. Prognostic value of malignant cells in pleural lavage at thoracotomy for bronchial carcinoma. Lung Cancer 1998; 21: 47–52.
Okada M, Tsubota N, Yoshimura M, Miyamoto Y, Maniwa Y. Role of pleural lavage cytology before resection for primary lung carcinoma. Ann Surg 1999; 229: 579–84.
Dresler CM, Fratelli C, Babb J. Prognostic value of positive pleural lavage in patients with lung cancer resection. Ann Thorac Surg 1999; 67: 1435–9.
Walker-Renard PB, Vaughan LM, Sahn SA. Chemical pleurodesis for malignant pleural effusions. Ann Intern Med 1994; 120: 56–64.
Yim APC, Chan ATC, Lee TW, Baker TR, Emrich LJ, Hartman AB. Thoracoscopic talc insufflation versus talc slurry for symptomatic malignant pleural effusion. Ann Thorac Surg 1996; 62: 1655–8.
Ichinose Y, Yano T, Asoh H, Yokoyama H, Fukuyama Y, Miyagi J et al. Intraoperative intrapleural hypotonic cisplatin treatment for carcinomatous pleuritis. J Surg Oncol 1997; 66: 196–200.
Read at the Fifty-second Annual Meeting of The Japanese Association for Thoracici Surgery, Symposium, Sendai, October 5–7, 1999
About this article
Cite this article
Higashiyama, M., Kodama, K., Yokouchi, H. et al. Clinical value of pleural lavage cytological positivity in lung cancer patients without intraoperative malignant pleuritis. Jpn J Thorac Caridovasc Surg 48, 611–617 (2000). https://doi.org/10.1007/BF03218215
- pleural lavage cytology
- lung cancer
- pleural recurrence
- recurrent pattern