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Yoshio Matsui



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    P2.09 - Pathology (Not CME Accredited Session) (ID 958)

    • Event: WCLC 2018
    • Type: Poster Viewing in the Exhibit Hall
    • Track:
    • Presentations: 1
    • Moderators:
    • Coordinates: 9/25/2018, 16:45 - 18:00, Exhibit Hall
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      P2.09-22 - Relevance of Results of Intraoperative Pleural Lavage Cytology and Histological Subtype in Lung Adenocarcinoma (ID 12713)

      16:45 - 18:00  |  Author(s): Yoshio Matsui

      • Abstract
      • Slides

      Background

      Pleural lavage cytology (PLC) can be simply and easily performed on patients undergoing surgery for primary lung cancers. Although clinical factors related to tumor progression, such as lymph node metastasis and pleural invasion, are reportedly risk factors for positive PLC, the association between PLC and histological subtype remains unknown. The present study aimed to evaluate the impact of a micropapillary pattern (MPP) in lung adenocarcinomas on results of PLC and assess the complementary role of these two factors as prognostic predictors and their significance in a clinical setting.

      a9ded1e5ce5d75814730bb4caaf49419 Method

      We retrospectively reviewed 600 consecutive patients with surgically resected pulmonary adenocarcinomas and investigated the relationship between PLC status and clinicopathological factors including a histologically identified MPP component. In cases of MPP observed ≥5% in a largest cut surface was defined as MPP-positive group.

      4c3880bb027f159e801041b1021e88e8 Result

      Twenty-five patients (4.2%) had positive PLC results. Positive PLC was significantly associated with MPP (p=0.0001), lymph node metastasis (p=0.01), and pleural invasion (p<0.0001) according to multivariate analysis. Patients with other established predictive factors for positive PLC, such as large tumor size, lymph node metastasis, pleural invasion, and lymphovascular invasion, have an increased risk of positive PLC when their tumor include histological MPP. With regard to lymph node metastasis, two factors, MPP and positive PLC, were associated with a higher incidence of occult N2 lymph node metastases. Among 25 patients with positive PLC, 18 (72%) were upstaged in postoperative pathologic examination whereas 139 of 575 (24%) patients with negative PLC were upstaged postoperatively. The prognosis of adenocarcinomas with MPP or positive PLC was significantly worse than that of patients without these features. Moreover, the survival rate of MPP and positive PLC group (MPP+ PLC+) was significantly worse than that of MPP and negative PLC group (MPP+ PLC−, p=0.03). Postoperative recurrences were found in 52% (13/25) of patients with positive PLC and 18% (103/575) of patients with negative (p<0.001).

      8eea62084ca7e541d918e823422bd82e Conclusion

      The presence of MPP in lung adenocarcinoma can be an independent predictor of positive PLC. These two factors have complementary and synergistic roles as prognostic factors. Detailed pre- or intra-operative examination of histological subtype and intraoperative PLC findings may provide important information for prediction of tumor progression and decisions regarding surgical procedure.

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