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Ann Thorac Surg 2005;80:1564
© 2005 The Society of Thoracic Surgeons

Correspondence

Intraoperative Pleural Lavage Cytology Should Not Influence Decision for Radical Surgery in Nonsmall Cell Lung Cancer

C.S. Pramesh, MS, FRCS, Rajesh C. Mistry, MS, Jaiprakash Agarwal, MD

Division of Thoracic Surgery and Radiotherapy Department of Surgical Oncology, Tata Memorial Hospital Mumbai, 400012 India

(Email: cspramesh{at}vsnl.net).

To the Editor:

We read with interest Vicidomini and colleagues' [1] article on the importance of intraoperative pleural lavage cytology as a prognostic factor in nonsmall cell lung cancer (NSCLC). This study corroborates the results of previous studies [2, 3] on the topic in identifying positive pleural lavage cytology (PLC) as an independent prognostic factor in patients with NSCLC. We agree with the authors that it has been shown to be an important and probably independent prognostic factor. However, to conclude that these patients have to be considered to have "subclinical malignant pleural effusion and classified as T4 disease" seems erroneous. This conclusion would be untenable unless it is proven in large studies that patients with positive pleural lavage cytology (with otherwise localized operable disease) have a prognosis similar to other T4 patients. Classifying a tumor as T4 disease automatically changes the intent of treatment from potentially curative to palliative, and this cannot be done on relatively flimsy evidence. The authors go on to recommend that " potential objective [of pleural lavage cytology] is to exclude patients form useless surgery." This again is unacceptable as in the authors' own series, the 3-year survival of these patients is 30%, which would not be expected with other T4 tumors. Although the difference in 3-year survival between patients without and with positive PLC (65% and 30%, respectively) appears significant, a matched pair analysis (with patients matched for T and N stages) would give a more accurate estimation of the importance of pleural lavage cytology. To summarize, we strongly believe that although PLC may be an important prognostic factor for survival in NSCLC, current evidence is not strong enough to classify them as T4 tumors, and this denies a potentially curative treatment for these patients.


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  1. Vicidomini G, Santini M, Fiorello A, Parascandolo V, Calabro B, Pastore V. Intraoperative pleural lavageis it a valid prognostic factor in lung cancer?. Ann Thorac Surg 2005;79:254-257.[Abstract/Free Full Text]
  2. Buhr J, Berghauser KH, Gonner S, Kelm C, Burkhardt EA, Padberg WM. The prognostic significance of tumor cell detection in intraoperative pleural lavage and lung tissue cultures for patients with lung cancer J Thorac Cardiovasc Surg 1997;113:683-690.[Abstract/Free Full Text]
  3. Okada M, Tsubota N, Yoshimura M, Miyamoto Y, Maniwa Y. Role of pleural lavage cytology before resection for primary lung carcinoma Ann Surg 1999;229:579-584.[Medline]

Related Article

Intraoperative Pleural Lavage Cytology Should Not Influence Decision for Radical Surgery in Nonsmall Cell Lung Cancer: Reply
Giovanni Vicidomini, Mario Santini, and Vincenzo Pastore
Ann. Thorac. Surg. 2005 80: 1565. [Extract] [Full Text] [PDF]



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 Ann. Thorac. Surg.Home page
G. Vicidomini, M. Santini, and V. Pastore
Intraoperative Pleural Lavage Cytology Should Not Influence Decision for Radical Surgery in Nonsmall Cell Lung Cancer: Reply
Ann. Thorac. Surg., October 1, 2005; 80(4): 1565 - 1565.
[Full Text] [PDF]

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