According to a recent article published in the Annals of Thoracic Surgery, pleural lavage cytology is significantly associated with survival outcomes in patients with non-small cell lung cancer and should be incorporated into the staging of the disease.

Lung cancer remains the leading cause of cancer-related deaths in the U.S. In fact, lung cancer is responsible for more deaths than the following three leading causes of cancer-related deaths (breast cancer, lung cancer, and colon cancer) combined. Non-small cell lung cancer (NSCLC) accounts for approximately 75%-80% of all lung cancers. “Non-small cell” refers to the type of cell within the lung where the cancer originated.

Staging of lung cancer determines of the extent of spread of the cancer. Accuracy in staging is imperative since treatment options and prognosis are primarily dictated by stage. Currently, the stage of NSCLC is typically defined by the size of the cancer and by areas within the body that the cancer has invaded. However, since survival rates among patients with the same stage of NSCLC vary widely, researchers continue to evaluate other prognostic factors that may improve upon staging accuracy.

Researchers from Japan recently conducted a trial to evaluate the possible significance of results from pleural lavage cytology. The pleura is a thin membrane that lines the lungs and chest cavity. Pleural lavage cytology is the examination of cells obtained from washings of the pleura. This trial included nearly 1,200 patients with early NSCLC who underwent pleural lavage cytology between 1992 and 2001 before and after the surgical removal of their cancer.

Results from pleural lavage cytology were highly associated with survival rates at 5 years.

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  • Patients who had cancerous cells detected on pleural lavage cytology prior to surgery had a 5-year survival rate of 27%, compared with a survival rate of 71% if no cancerous cells were detected.
  • Patients who had cancerous cells detected on pleural lavage cytology following surgery had a 5-year survival rate of 10%, compared to a survival rate of 73% if no cancerous cells were detected.

The researchers concluded that results from pleural lavage cytology following surgery should be incorporated into the staging of early NSCLC; results from this procedure were as significantly correlated with survival as standard staging procedures. Future studies are necessary in order to bring pleural lavage cytology into standard practice.

Patients diagnosed with early NSCLC may wish to speak with their physician regarding their individual risks and benefits of pleural lavage cytology or the participation in a clinical trial further evaluating this procedure or other staging procedures. Two sources of information including ongoing clinical trials include the National Cancer Institute (www.cancer.gov) and www.cancerconsultants.com.

Reference: Enatsu S, Yoshida J, Yokose T, et al. Pleural Lavage Cytology Before and After Lung Resection in Non-Small Cell Lung Cancer Patients. Annals of Thoracic Surgery. 2006; 81:298-304.

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