PLC 'recommended for all early stage lung cancers'

The results of pleural lavage cytology (PLC) offer prognostic information on early-stage lung carcinomas and the procedure should be carried out routinely, even in patients with stage I non-small-cell lung cancer (NSCLC), recommend Japanese investigators.

While PLC, among other cytologic techniques, is regarded as potentially useful in determining the prognosis of lung cancers, it is not clear whether positive PLC findings in stage I NSCLC are a basis for performing radical surgery.

To investigate further, Yukitoshi Satoh, from the Cancer Institute Hospital in Tokyo, and colleagues performed PLC before lung manipulation or resection in 853 patients with no macroscopic pleural effusion, dissemination, or diffuse adhesions. In addition, all of the patients went to have curative resection for NSCLCs.

In all, 41 (4.8%) of the patients had positive findings on PLC, with high rates seen in those with adenosquamous carcinomas and adenocarcinomas, at 15.0% and 5.7%, respectively. Among patients with positive PLC results, 72% had distant metastases, while 25% had pleural recurrence. PLC-positive patients also had significantly poorer survival rates than other patients, even those with stage I disease.

After resection, six patients from the PLC-positive group were given hypotonic cisplatin as adjuvant therapy, while 15 were given distilled water infusion into the pleural space. While pleural recurrence was seen in just two of these patients, this had no impact on long-term outcomes, the team reports in the Annals of Thoracic Surgery.

The researchers write: "In conclusion, although the numbers of patients with positive PLC results were limited, as in many other studies on this topic, our results confirm that PLC findings are distinct prognostic factors for early-stage lung cancers in particular.

"We thus suggest that cytologic examination of PLC should be performed routinely, even for patients with early stage NSCLCs, before beginning curative resection."

In an accompanying commentary, Eric Linn, from Papworth Hospital in Cambridge, said: "The need to perform any adjunctive measure to increase the precision of staging can be expected to be met with lethargic uptake due to additional time, cost, and availability.

"Except PLC, [which] unlike other more sophisticated adjuncts, is simple to perform, inexpensive, and available."



Ann Thorac Surg 2007; 83: 197–203