Determining the prognosis in bronchial carcinoma by intraoperative pleural lavage

: Pleural lavage with 300 ml physiological saline was undertaken at thoracotomy (before and after resection) in a prospective study of 59 patients (49 males and 10 females; average age 59.7 years, range 41-76 years) with first manifestations of a bronchial carcinoma. The aim was to find out whether, even at an early stage of the tumour, there are tumour deposits in the pleural cavity. The lavage fluid was centrifuged and the sediment then embedded in paraffin and prepared for cytological examination. Tumour cells were demonstrated before resection in 27 patients (45.8%), in 23 of them also after the resection. Among 38 patients, previously classified as being in stage I, the lavage material was positive in 15 (39.5%); tumour cells were demonstrated in 5 of 18 patients in stage pT1. The cumulative two-year survival rate of non-small-cell bronchial carcinoma in stage I (n = 32) was 39.9% if the lavage was positive, 97.4% if negative (P less than 0.01). The results indicate that a positive finding on pleural lavage corresponds to a pT4 stage with a poor life expectancy.