PLEURAL CYTOLOGIES IN LUNG-CANCER WITHOUT PLEURAL EFFUSIONS

Background. Malignant pleural effusions significantly increase the sta ge of lung cancer with attendant worsening of prognosis. There is a pa ucity of literature evaluating malignant pleural lavage cytology in pa tients without pleural effusions. We propose to determine the incidenc e of malignant pleural cytologies in patients without pleural effusion s who undergo curative resection for lung cancer and to identify any p redictive risk factors for positive cytology. Methods. Seventy-eight p atients underwent curative resection for lung cancer. Lavage was perfo rmed before lung manipulation and after resection and cytologically ev aluated. Results. Twelve pneumonectomies, 64 lobectomies, and 2 wedge resections were performed on 40 men and 38 women with an average age o f 65.7 years. Fourteen percent had positive lavage cytology before lun g resection with an 11% (6 of 53) incidence in stage I. A significant correlation to adenocarcinoma compared with squamous cell was found (p = 0.03) but not to stage, T or N status, grade, pleural invasion, or preoperative transthoracic needle biopsy. Conclusions. The incidence o f positive pleural cytology in otherwise stage I patients is disconcer tingly high. Positive cytology may be a prognosticator of a more aggre ssive tumor biology. (C) 1997 by The Society of Thoracic Surgeons.