J Thorac Cardiovasc Surg 2003;126:610-611
© 2003 The American Association for Thoracic Surgery
Malignant status at surgical margin of limited-resected non–small cell lung cancer: a crucial finding for predicting local relapse
Noriyoshi Sawabata, MDa
a Division of Surgery, Toneyama National Hospital, Osaka, Japan
To the Editor:
In a recent issue, Higashiyama and colleagues1 reported on the malignant status of the surgical margin of limited-resected non–small cell lung cancer (NSCLC). They concluded that the cytologically negative results of examination of the surgical margin by the technique of intraoperative lavage in limited surgery for lung cancer may be predict lack of local recurrence in the surgical margin. The results in Higashiyama and colleagues’ study1 are similar to those of my own investigation.2 As such, I believe Higashiyama and colleagues’ technique is also useful to find out whether NSCLC has been resected completely.
Although no recurrence on the malignant negative surgical margin was found in Higashiyama and colleagues’ study,1 I have a criticism of their technique in correcting cells on the surgical margin. It is not rare that malignant cells exist on the pleura in the naked situation3 and after needle aspiration cytologic examination.4 Their complicated technique was lavage cytologic examination without flooding the pleura. If the pleura is flooded for even a short while, malignant cells on the pleura contaminate it. However, it is difficult to avoid flooding the pleura with saline solution in a cup. Further, the spun cells degenerate, for a less exact diagnosis than with smeared cells. The run-across method, which is smeared cell cytologic examination—the glass slide is run across the whole of the surgical margin4,5—is so simple and little contaminated that the malignant positive rate on the surgical margin of excised resected non–small cell lung cancer has been higher than with Higashiyama and colleagues’ technique.1 Whether the run-across method is more sensitive or Higashiyama and colleagues’ technique is less accurate has been unclear, because both studies1,2 have small numbers of patients with malignant positive margins. Further study is needed to find the significance of malignant status on the surgical margin of limited-resected resected non–small cell lung cancer.
 |
References
|
|---|
- Higashiyama M, Kodama K, Takami K, Higaki N, Nakayama T, Yokouchi H. Intraoperative lavage cytologic analysis of surgical margins in patients undergoing limited surgery for lung cancer. J Thorac Cardiovasc Surg. 2003;125:101–107[Abstract/Free Full Text]
- Sawabata N, Matsumura A, Ohta M, Maeda H, Hirano Y, Nakagawa K, et al. Cytologically malignant margins of wedge resected stage I non–small cell lung cancer. Ann Thorac Surg. 2002;74:1953–1957[Abstract/Free Full Text]
- Ichinose Y, Yano T, Asoh H, Yokoyama H, Fukuyama Y, Katsuda Y. Diagnosis of visceral pleural invasion in resected lung cancer using a jet stream of saline solution. Ann Thorac Surg. 1997;64:1626–1629[Abstract/Free Full Text]
- Sawabata N, Ohta M, Maeda H. Fine-needle aspiration cytologic technique for lung cancer has a high potential of malignant cell spread through the tract. Chest. 2000;118:936–939[Medline]
- Sawabata N, Mori T, Iuchi K, Maeda H, Ohta M, Kuwahara O. Cytologic examination of surgical margin of excised malignant pulmonary tumor: methods and early results. J Thorac Cardiovasc Surg. 1999;117:618–619[Free Full Text]
Top
References