Sawabata Noriyoshi, Matsumura Akihide, Ohota Mitsunori, Maeda Hajime, Hirano Hiroshi, Nakagawa Katsuhiro, Matsuda Hikaru
Division of Surgery, Clinical Pathology, Toneyama National Hospital, Toyonaka, Osaka, Japan.
Ann Thorac Surg. 2002 Dec;74(6):1953-7. doi: 10.1016/s0003-4975(02)03993-0.
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.
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.
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.
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.
我们开发了一种使用细胞学技术检测肺恶性肿瘤手术切缘的新方法（即玻片划过吻合钉部位的横扫法），并评估了该方法在预测切缘复发和预后方面是否有用。
1996年4月至1999年3月，对15例患有心肺功能损害的患者的15处I期非小细胞肺癌（NSCLC）病变（最大直径为10至35毫米，中位数为20毫米）进行了切除，未进行额外的近端切除。使用横扫法检查手术切缘。有8名男性和7名女性患者，年龄在51至80岁之间。1例患者接受了电视辅助胸腔镜手术，14例接受了开胸手术。患者的术前诊断为13例腺癌、2例鳞状细胞癌和1例未确诊病变（1例腺癌）。随访期为37至63个月。
细胞学阳性率为47%，而组织学阳性率为20%。有4例切缘复发患者（其中3例组织学切缘为阴性），在细胞学阳性患者中的复发率为57%，而在细胞学阴性患者中为0%（p = 0.03）。在细胞学阴性组和阳性组之间的生存比较中，没有统计学上的显著差异。
横扫法在确认完全切除方面也很有用。即使非小细胞肺癌切除时组织学切缘为阴性，细胞学切缘阳性也可能导致切缘复发。
