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Chen D, Fu R, Shi P, Qin S, Chen C. [Latest Progress of Intraoperative Pleural Lavage Cytology in Lung Cancer Surgery]. ZHONGGUO FEI AI ZA ZHI = CHINESE JOURNAL OF LUNG CANCER 2018; 21:719-726. [PMID: 30201073 PMCID: PMC6137007 DOI: 10.3779/j.issn.1009-3419.2018.09.12] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
非小细胞肺癌(non-small cell lung cancer, NSCLC)根治术中胸腔冲洗液细胞学检查是一种常用的检测肿瘤进展并评估患者预后的诊断技术。长期以来大量研究者致力于阐明术中胸腔冲洗液细胞学检查结果与肺癌患者术后生存及肿瘤复发转移的关系。由于不同研究间存在明显异质性,其结论也各有不同。但能肯定的是,胸腔冲洗液肿瘤细胞检查阳性已被证实为手术患者的不良预后因素之一。本文尝试从临床意义、影响因素及可能发生机制等角度就近年来术中胸膜腔冲洗的研究进展作一综述。
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Affiliation(s)
- Donglai Chen
- Department of Thoracic Surgery, Shanghai Pulmonary Hospital, Tongji University School of Medicine, Shanghai 200433, China
| | - Ranran Fu
- Tongji University School of Medicine, Shanghai 200092, China
| | - Pingfan Shi
- Tongji University School of Medicine, Shanghai 200092, China
| | - Shuang Qin
- Tongji University School of Medicine, Shanghai 200092, China
| | - Chang Chen
- Department of Thoracic Surgery, Shanghai Pulmonary Hospital, Tongji University School of Medicine, Shanghai 200433, China
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Nakamura T, Otsuki Y, Nakamura H, Funai K. Pleural lavage cytology after lung resection in patients with non-small cell lung cancer and the feasibility of 20 mL saline solution. Asian J Surg 2018; 42:283-289. [PMID: 29628439 DOI: 10.1016/j.asjsur.2018.03.001] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2018] [Revised: 03/12/2018] [Accepted: 03/16/2018] [Indexed: 10/17/2022] Open
Abstract
BACKGROUND There are two issues to be discussed in pleural lavage cytology (PLC) for resected non-small cell lung cancer (NSCLC) whether it should be performed before (pre-PLC) or after (post-PLC) the lung resection and the dose of saline varies widely among the institutions. METHODS We retrospectively reviewed the clinical records of 466 consecutive patients who underwent a curative resection for NSCLC and received both a pre- and post- PLC using 20 mL of saline from January 2001 to December 2011. RESULTS There were 24/28 of positive pre- and post-PLC and 442/438 negative pre- and post-PLCs, respectively. Patients with a positive pre- or post-PLCs had significantly worse 5-year survival rates than those with negative results (pre-PLC positive/negative; 32.6%/69.9%, p = 0.001, post-PLC positive/negative; 21.4%/71.1%, p < 0.001, respectively). The post-PLC (p = 0.01) was an independent prognostic factor for the overall survival by a multivariate analysis, whereas the pre-PLC was not (p = 0.79). CONCLUSIONS The post-PLC was a more significant prognostic factor than the pre-PLC. Further, 20 mL of saline seemed feasible because of the consistent results compared to the past reports using a greater dose of saline for regarding the positive rates of the PLC and its prognostic significance.
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Affiliation(s)
- Toru Nakamura
- Department of General Thoracic Surgery, Seirei Hamamatsu General Hospital, 2-12-12 Sumiyoshi, Hamamatsu, Shizuoka, Japan.
| | - Yoshiro Otsuki
- Department of Pathology, Seirei Hamamatsu General Hospital, 2-12-12 Sumiyoshi, Hamamatsu, Shizuoka, Japan
| | - Hidenori Nakamura
- Department of Respiratory Medicine, Seirei Hamamatsu General Hospital, 2-12-12 Sumiyoshi, Hamamatsu, Shizuoka, Japan
| | - Kazuhito Funai
- First Department of Surgery, Hamamatsu University School of Medicine, 1-20-1 Handa-yama, Hamamatsu, Shizuoka, Japan
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Wu YB, Xu LL, Wang XJ, Wang Z, Zhang J, Tong ZH, Shi HZ. Diagnostic value of medical thoracoscopy in malignant pleural effusion. BMC Pulm Med 2017; 17:109. [PMID: 28778184 PMCID: PMC5544982 DOI: 10.1186/s12890-017-0451-1] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2016] [Accepted: 07/27/2017] [Indexed: 12/18/2022] Open
Abstract
Background Medical thoracoscopy has been shown to be an efficacious procedure in diagnosing unexplained exudative pleural effusions with excellent safety. This study aimed to assess the diagnostic significance of thoracoscopy in the management of patients with malignant pleural effusion (MPE). Methods Consecutive patients with malignant pleural effusion were retrospectively reviewed, and their demographic, radiographic, thoracoscopic and histological data were collected. Results Between July 2005 and June 2014, 342 of 833 patients undergoing thoracoscopy were finally confirmed to suffer from MPE. The top three frequent causes of MPE were metastatic carcinoma (79.5%), malignant mesothelioma (10.2%), and lymphoma (2.9%). Among metastatic malignancies, the most common cancer was lung cancer (85.2%), followed by breast cancer (4.4%), ovarian cancer (2.2%), pancreatic cancer (1.8%), etc. No serious adverse events associated with thoracoscopy were recorded. Conclusions Medical thoracoscopy is a valuable and safe tool in diagnosing malignant pleural effusion with minimal complication rates.
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Affiliation(s)
- Yan-Bing Wu
- Department of Respiratory and Critical Care Medicine, Beijing Institute of Respiratory Medicine and Beijing Chaoyang Hospital, Capital Medical University, Beijing, China
| | - Li-Li Xu
- Department of Respiratory and Critical Care Medicine, Beijing Institute of Respiratory Medicine and Beijing Chaoyang Hospital, Capital Medical University, Beijing, China
| | - Xiao-Juan Wang
- Department of Respiratory and Critical Care Medicine, Beijing Institute of Respiratory Medicine and Beijing Chaoyang Hospital, Capital Medical University, Beijing, China
| | - Zhen Wang
- Department of Respiratory and Critical Care Medicine, Beijing Institute of Respiratory Medicine and Beijing Chaoyang Hospital, Capital Medical University, Beijing, China
| | - Jun Zhang
- Department of Respiratory and Critical Care Medicine, Beijing Institute of Respiratory Medicine and Beijing Chaoyang Hospital, Capital Medical University, Beijing, China
| | - Zhao-Hui Tong
- Department of Respiratory and Critical Care Medicine, Beijing Institute of Respiratory Medicine and Beijing Chaoyang Hospital, Capital Medical University, Beijing, China
| | - Huan-Zhong Shi
- Department of Respiratory and Critical Care Medicine, Beijing Institute of Respiratory Medicine and Beijing Chaoyang Hospital, Capital Medical University, Beijing, China.
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Fukui T, Yokoi K. The role of surgical intervention in lung cancer with carcinomatous pleuritis. J Thorac Dis 2016; 8:S901-S907. [PMID: 27942413 DOI: 10.21037/jtd.2016.06.36] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Patients with non-small cell lung cancer (NSCLC) associated with carcinomatous pleuritis are currently classified as having stage IV disease per the 7th edition of the tumor-node-metastasis (TNM) system, which means that the disease is deemed incurable. In fact, the 5-year survival rate of these patients was only 2% in a large global cohort collected by the International Association for the Study of Lung Cancer. However, patients with carcinomatous pleuritis have heterogeneous conditions. Some have minimal pleural effusion, which is first detected at thoracotomy; some have numerous pleural nodules without any effusion; and others have massive effusion and nodules with symptoms. Several investigators have reported the contribution of surgical intervention to favorable outcomes of patients with carcinomatous pleuritis first detected at thoracotomy. These reports show a relatively higher 5-year survival rate of 15% to 37%. The extrapleural pneumonectomy (EPP) is a radical surgical procedure that is commonly employed in the treatment of malignant pleural mesothelioma. Two authors reported that they have successfully performed EPPs for the treatment of patients with carcinomatous pleuritis. Their 5-year survival rates were estimated to be 22% and 61%, a significantly improved outcome. Although the development of chemotherapeutic agents, including molecular targeted drugs, might have the potential to prolong the survival of patients with advanced lung cancer, surgical interventions including EPP might have a role in improving the survival of patients with carcinomatous pleuritis of minimal disease and those without massive effusion or numerous pleural nodules.
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Affiliation(s)
- Takayuki Fukui
- Department of Thoracic Surgery, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Kohei Yokoi
- Department of Thoracic Surgery, Nagoya University Graduate School of Medicine, Nagoya, Japan
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Prognostic Value of Pleural Lavage Cytology in Patients with Lung Cancer Resection: An Updated Meta-Analysis. PLoS One 2016; 11:e0157518. [PMID: 27458805 PMCID: PMC4961387 DOI: 10.1371/journal.pone.0157518] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2016] [Accepted: 05/30/2016] [Indexed: 11/19/2022] Open
Abstract
OBJECTIVE Pleural lavage cytology (PLC) is considered as a possible tool for assessing prognosis of lung cancer patients. We aimed to comprehensively review the prognosis value of PLC in patients undergoing surgical resection. METHODS We searched 4 electronic databases for relevant studies comparing positive PLC and negative PLC. The primary outcomes included survival rate and recurrence rate at maximum follow-up. RESULTS The meta-analysis included 28 studies, with a total of 20,714 patients. For the overall survival rate of all stages, the results demonstrated that positive pre-resection, post-resection and pooled PLC were associated with unfavorable survival: hazard ratio (HR) 2.89 (95% confidence interval [CI] 2.48-3.37), 2.70 (1.90-3.83), and 2.89 (2.52-3.31), respectively. For the stage I survival rate, the combined results also suggested that positive pre-resection, post-resection and pooled PLC were associated with unfavorable survival: HR 3.29 (95% CI 2.55-4.25), 4.85 (2.31-10.20), and 3.16 (2.53-3.94), respectively. Furthermore, a meta-analysis of 14 studies included 14,279 patients showed that positive pre-resection, post-resection and pooled PLC were associated with an increased risk of overall recurrence: risk ratio (RR) 2.45 (95% CI 1.91-3.15), 2.37 (1.11-5.09), and 2.37 (95% CI 2.00-2.80), respectively. Positive PLC was also associated with a high pleural recurrence (RR 4.77; 95% CI 3.13-7.26) or distant recurrence (RR 2.33; 95% CI 1.65-3.29). CONCLUSIONS Both positive pre- resection and post-resection PLC are associated with not only higher tumor recurrence but also unfavorable survival outcomes in patients with lung cancer resection. This technique can therefore act as a strong prognostic factor for tumor recurrence and adverse survival rates.
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Zou J, Bella AE, Chen Z, Han X, Su C, Lei Y, Luo H. Frequency of EGFR mutations in lung adenocarcinoma with malignant pleural effusion: Implication of cancer biological behaviour regulated by EGFR mutation. J Int Med Res 2015; 42:1110-7. [PMID: 25239875 DOI: 10.1177/0300060514539273] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022] Open
Abstract
OBJECTIVE A retrospective single-centre study to compare the clinical features of patients with lung adenocarcinoma with and without epidermal growth factor receptor (EGFR) mutations. METHODS Pretreatment medical records of patients with lung adenocarcinoma were reviewed. DNA was extracted from paraffin wax-embedded tumour tissue for analysis of EGFR mutations. Malignant pleural effusion (MPE) was diagnosed by cytopathological testing of pleural fluid. RESULTS EGFR mutations (19-Del and L858R) were recorded in 81/283 patients (28.6%). MPE was found in 42/283 patients (14.8%). In patients with stage IV disease, the frequency of EGFR mutations was higher in those with MPE than in those without MPE. EGFR mutations were independently associated with female sex, no history of smoking and presence of MPE. CONCLUSIONS There was a positive association between EGFR mutation and the presence of MPE. EGFR mutations may play an important role in the formation of MPE.
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Affiliation(s)
- JianYong Zou
- Department of Thoracic Surgery, The First Affiliated Hospital of Sun Yat-Sen University, Guangzhou, China
| | - Amos Ela Bella
- Department of Thoracic Surgery, Cancer Centre of Sun Yat-Sen University, Guangzhou, China
| | - ZhenGuang Chen
- Department of Cardiothoracic Surgery, Huangpu Branch of the First Affiliated Hospital of Sun Yat-Sen University, Guangzhou, China
| | - XiangQian Han
- The Department of Thoracic Surgery, The First Affiliated Hospital of NanYang Medical College, HeNan, China
| | - ChunHua Su
- Department of Thoracic Surgery, The First Affiliated Hospital of Sun Yat-Sen University, Guangzhou, China
| | - YiYan Lei
- Department of Thoracic Surgery, The First Affiliated Hospital of Sun Yat-Sen University, Guangzhou, China
| | - HongHe Luo
- Department of Thoracic Surgery, The First Affiliated Hospital of Sun Yat-Sen University, Guangzhou, China
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Nakao M, Hoshi R, Ishikawa Y, Matsuura Y, Uehara H, Mun M, Nakagawa K, Okumura S. Prognosis of non-small-cell lung cancer patients with positive pleural lavage cytology. Interact Cardiovasc Thorac Surg 2015; 20:777-82. [DOI: 10.1093/icvts/ivv047] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2014] [Accepted: 01/23/2015] [Indexed: 11/12/2022] Open
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Kameyama K, Okumura N, Miyaoka E, Asamura H, Yoshino I, Tada H, Fujii Y, Nakanishi Y, Eguchi K, Mori M, Kobayashi H, Sawabata N, Okumura M, Yokoi K. Prognostic value of intraoperative pleural lavage cytology for non–small cell lung cancer: The influence of positive pleural lavage cytology results on T classification. J Thorac Cardiovasc Surg 2014; 148:2659-64. [DOI: 10.1016/j.jtcvs.2014.07.090] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/13/2013] [Revised: 06/23/2014] [Accepted: 07/13/2014] [Indexed: 11/26/2022]
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Takehara H, Makita M, Tanaka R, Tsuchiya M, Naya M, Hayashi M. Lung toxicity assessment using bronchoalveolar lavage fluid and pleural lavage fluid cytology by intratracheal treatment in rats. J Toxicol Sci 2014; 39:141-5. [PMID: 24418718 DOI: 10.2131/jts.39.141] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/02/2022]
Abstract
Usefulness of bronchoalveolar lavage fluid (BALF) and pleural cavity lavage fluid (PLF) as an experimental material was evaluated for the assessment of pulmonary toxicity of chemicals in rats. From the viewpoint of safety, isoflurane can be used for euthanasia/anesthesia because there was no difference in biological properties of BALF between diethyl ether and isoflurane. Here, we also recognized phosphate buffered saline (PBS) and distilled water equally as a solvent/vehicle for negative control. PLF is also provided as a useful target material as well as BALF for assessing chemical lung toxicity. To evaluate the method, we used zinc chloride as a model chemical and obtained the expected and satisfied results. We may conclude that the intratracheal treatment and combination usage of BALF and PLF as a target material is a good method for assessment of chemical pulmonary (lung and plural cavity) toxicity in rats.
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Affiliation(s)
- Hiroshi Takehara
- Public Interest Incorporated Foundation BioSafety Research Center (BSRC)
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Pleural lavage cytology: Where do we stand? Lung Cancer 2014; 83:14-22. [DOI: 10.1016/j.lungcan.2013.10.012] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2013] [Revised: 10/08/2013] [Accepted: 10/18/2013] [Indexed: 11/19/2022]
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Igai H, Matsuura N, Tarumi S, Chang SS, Misaki N, Go T, Ishikawa S, Yokomise H. Clinicopathological study of p-T1aN0M0 non-small-cell lung cancer, as defined in the seventh edition of the TNM classification of malignant tumors. Eur J Cardiothorac Surg 2011; 39:963-7. [DOI: 10.1016/j.ejcts.2010.09.008] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/08/2010] [Revised: 08/30/2010] [Accepted: 09/05/2010] [Indexed: 10/18/2022] Open
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Yang CL, Liu SS, Ma YG, Liu YY, Xue YX, Huang B. The influence of intraoperative pleural perfusion with matrine-cisplatin or cisplatin on stromal cell-derived factor-1 in non-small cell lung cancer patients with subclinical pleural metastasis. Med Oncol 2011; 29:574-81. [PMID: 21312072 DOI: 10.1007/s12032-011-9849-4] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2011] [Accepted: 01/27/2011] [Indexed: 10/18/2022]
Abstract
The early diagnosis and treatment of non-small cell lung cancer (NSCLC) in patients with subclinical pleural metastasis is currently a challenge. In an effort to establish a method for the diagnosis and treatment of these patients, we conducted a single-blind study during which intraoperative pleural lavage cytology (PLC) was performed in 164 patients with NSCLC without obvious pleural effusion. Stromal cell-derived factor-1 (SDF-1) serum concentrations were analyzed using enzyme-linked immunoassay on day 1 prior to tumor resection and on day 7 postoperatively. Western blot analysis was used for the detection of CXCR4 protein expression in resected tumors. Intraoperative pleural perfusion chemotherapy, with either cisplatin or cisplatin plus matrine, was given to patients with positive PLC. A group of 30 patients with NSCLC that did not undergo intraoperative PLC were used as a control group. Of the 164 study patients, 41 (25%) patients had positive PLC. Serum SDF-1 concentrations were higher in PLC-positive patients compared with patients negative for PLC and control patients. Serum SDF-1 concentrations were also lower at postoperative day 7 in patients treated with cisplatin plus matrine compared with control patients and those perfused with cisplatin alone. A lower incidence of chemotherapy-related adverse events was observed in patients treated with cisplatin plus matrine versus those treated with cisplatin alone during the first postoperative month. Patients with positive PLC showed a higher CXCR4 protein expression than patients with negative PLC. Based on the results of this study, PLC combined with serum SDF-1 concentration measurements may be considered as an effective index to determine the risk of subclinical pleural metastasis in patients with lung cancer. In addition, cisplatin plus matrine was confirmed as an initial approach for pleural perfusion and was superior to cisplatin alone.
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Affiliation(s)
- Cheng-Liang Yang
- The First Affiliated Hospital, Liaoning University of Chinese Traditional Medicine, No. 79 of Chongshan Eastern Road, 110032 Huanggu District, Shenyang, Liaoning Province, China.
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Aokage K, Yoshida J, Ishii G, Enatsu S, Hishida T, Nishimura M, Nishiwaki Y, Nagai K. The impact on survival of positive intraoperative pleural lavage cytology in patients with non–small-cell lung cancer. J Thorac Cardiovasc Surg 2010; 139:1246-52, 1252.e1. [DOI: 10.1016/j.jtcvs.2009.07.049] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/23/2008] [Revised: 06/09/2009] [Accepted: 07/16/2009] [Indexed: 11/16/2022]
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