PROGNOSTIC VALUE OF MALIGNANT-CELLS IN PLEURAL LAVAGE AT THORACOTOMY FOR BRONCHIAL-CARCINOMA

Despite seemingly radical surgery many patients operated on for bronch ial carcinoma will die from their disease. Some patients might benefit from postoperative treatment and a prognostic factor that could ident ify those with an increased risk for tumor relapse would be of great c linical importance. One possible such factor is the occurrence of mali gnant cells in pleural lavage performed at operation. To test this hyp othesis 224 consecutive patients who had been operated on due to verif ied or strongly suspected bronchial carcinoma, preoperatively staged a s stage I or II, were investigated. After opening the thorax and befor e manipulation or palpation of the lungs, 300 ml of physiological sali ne solution was installed into the pleura. After excluding patients wh o were not radically operated, there remained 138 patients with histol ogically confirmed lung cancer (carcinoids excluded) and 12.3% showed tumour cells in the washings. Two of 18 patients with metastatic lung disease (11%) and one of ten patients with carcinoid tumor also showed malignant cells in the lavage. The patients with lung cancer have bee n followed for 3 years or until death. After three years 60.2% of thos e without malignant cells in the pleural lavage were still alive, whil e this figure was 41.2% in the other group. The difference was not sta tistically significant. Other factors, such as spread to local lymph n odes, size of tumor, etc. were related to the occurrence of malignant cells in the pleura, and these factors were also better prognostic one s. We conclude that the clinical use of pleural lavage cytology is lim ited. (C) 1998 Elsevier Science Ireland Ltd. All rights reserved.