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Ann Thorac Surg 2002;74:1953-1957
© 2002 The Society of Thoracic Surgeons

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Original article: general thoracic

Cytologically malignant margins of wedge resected stage I non-small cell lung cancer

^a Division of Surgery, Clinical Pathology, Toneyama National Hospital, Osaka, Japan
^B Division of Surgery, Kinki Central National Hospital for Chest Diseases Osaka, Japan
^C Division of General Thoracic Surgery, Department of Surgery (E-1), Osaka University Graduate School of Medicine Osaka, Japan
^D Division of Surgery, Habikino Hospital, Osaka, Japan

Accepted for publication June 28, 2002.

* Address reprint requests to Dr Sawabata, Division of Surgery, Toneyama National Hospital, 5-1-1 Toneyama, Toyonaka, Osaka 560-8552, Japan.
e-mail: nori{at}toneyama.hosp.go.jp

BACKGROUND: We have developed a novel test for the surgical margin of pulmonary malignant tumor using a cytologic technique (the run-across method in which a glass slide is run across the staple site), and we have assessed whether this method is useful in predicting margin relapse and prognosis.

METHODS: From April 1996 to March 1999, 15 lesions of stage I non-small cell lung cancer (NSCLC) (maximum diameter ranged from 10 to 35 mm with a median of 20 mm) from 15 patients with cardiopulmonary impairment were excised without additional proximal resections. The surgical margin was examined using the run-across method. There were 8 male 7 female patients whose ages ranged from 51 to 80 years. One patient underwent video-assisted thoracic surgery and 14 underwent thoracotomy. The preoperative diagnoses of the patients were 13 adenocarcinomas, 2 squamous cell carcinomas, and 1 undiagnosed lesion (1 adenocarcinoma). The follow-up period ranged from 37 to 63 months.

RESULTS: The rate of positive cytology was 47% in comparison with the rate of positive histology of 20%. There were 4 patients with margin relapse (3 of them contained negative histology margins) at a rate of 57% among the positive cytology patients in comparison with 0% among the negative cytology patients (p = 0.03). In a comparison of survival between the negative cytology group and the positive cytology group, there were no statistically significant differences.

CONCLUSIONS: The run-across method is also useful in confirming complete resection. A positive cytology margin could lead to margin relapse even if a non-small cell lung cancer is resected with a negative histology margin.

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