Abstract
Cytological examination of pleural effusions is important in patients with primary lung cancer in order to determine the treatment schedule and estimate the prognosis. We report here on patients with pleural lavage positive cytology but little or no pleural effusion.
Group A : From June 1985 to November 1987, cytological examinations of pleural lavage fluid (intra-operative diagnosis) were conducted in 107 primary lung cancer patients in whom no pleural effusion could be detected macroscopically at the time of thoracotomy. In five patients (4.6 %) the fluid ware cytologically positive. All five had adenocarcinoma (9 % of the 56 with adenocarcinoma). One case was free from P and PM factors, although others were complicated with those factors. All five died recurrence within 5 years, including one patient without lymph node metastasis.
Group B : From July 1984 to May 1992, of the 522 primary lung cancer patients who underwent thoracotomy, 78 had very little pleural fluid and cytological examination of pleural lavage was done. Fourteen had positive cytology.
In the j patients in group A, the 3-year survival rate was 40.0 %, and the 5-year survival rate was 0 %. In the 14 positive patients of Group B, it was 30.5 % and 0 % respectively. The difference in survival between the two groups was not signifiant. These survival rates are significantly lower than those of patients with stage I or II primary lung cancer (p<0.005), but are similar to those of patients with stage III or IV cancer. Thus, cytological positivity is associated with a worse prognosis irrespective of the presence of pleural effusion. The above findings should be considered in the planning of the staging and treatment of primary lung cancer.
