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Hypothesis Cytologic analysis of intraoperative lavage at the surgical margin during wedge or segmental resection for pulmonary metastatic lesions predicts postoperative local failure at the surgical margin of the pulmonary parenchyma. Design Prospective nonrandomized trial. Settings Institution-based study. Patients Fifty-one consecutive patients undergoing wedge or segmental resection for 87 pulmonary metastatic lesions of various primary tumor types from November 1, 1997, through January 31, 2001, were prospectively enrolled. Interventions An intraoperative lavage cytologic technique at the surgical margin for each pulmonary metastasis was performed as described previously. Main Outcome Measures Incidence of positive cytologic findings and postoperative local recurrence at the surgical margin. Results Of the examined lesions, 10 (11%) showed positive cytologic results at the surgical margin, despite a macroscopically safe margin in the attempted resection. Of these, metastasectomy was converted to segmentectomy in 3. An additional wedge resection and evaporation using an Nd:YAG laser in the surgical margin were performed in 1 and 4 lesions, respectively. Complications precluded further treatment in 2 lesions. By July 2001, although no local recurrence at the surgical margin area was found among the lesions with negative cytologic results, recurrence at the surgical margin occurred in 2 with positive cytologic results, including 1 receiving no treatment and 1 receiving Nd:YAG laser evaporation, indicating that a significant difference in the recurrence rate according to lavage cytologic status ( P Conclusions This intraoperative lavage cytologic technique in wedge or segmental resection of pulmonary metastases of various primary tumors may be a useful predictor of local recurrence at the surgical margin. With these test results, local recurrence at the surgical margin may be controllable in patients undergoing pulmonary metastasectomy.

The cytological presentation of nonpapillary in situ carcinoma of the urinary bladder was studied.In all 5 cases, a diagnosis of malignancy has been made by cytological examination of voided urine at a time when the patients had in situ carcinoma. The symptoms of the cases, such as pain on urination and urinary frequency, suggested chronic cystitis. There was no specific picture to be made by cytoscopy. But cancer cells were found in all 5 cases.The characteristic features of malignant cells in urinary sediment from the patients with carcinoma in situ were studied, and a comparison was made with the features of malignant cells from invasive carcino ma. Cytological smears of urine from the 5 patients showed little evidence of inflammation and none of necrosis, a uniform pattern of relatively small malignant cells. Most of these cells were 13-14 microns in size, round or oval in shape. Anisocytosis was rare. Nuclei were slightly enlarged and also round or oval in shape;there were always hyperchromatic nuclei with finely distributed chromatin. A few large cells and malignant cells with degenerated bizarre nuclei were found, mixed with the uniform pattern of malignant cells.These large and malignant cells were numerous in cytological smears of urine from patients with invasive carcinoma.Biopsy specimens appearances are sometimes misle ading and apt to be diagnosed as chronic cystitis, since nonpapillary in situ carcinoma denudes easily. Therefore, routine cytological examination of urinary sediment is most useful in the detection of carcinoma in situ of the urinary bladder.

In this paper is presented the method of sputum cytology which was developed by Saccomanno.This method has been used in the Mayo Lung Project in U.S.A.Comparison between the cellular features of direct smears obtained by the transbronchial brushing or the needle aspiration technique, and of smears that had remained in Saccomanno's solution for 1, 2 and 4weeks showed that epidermoid carcinoma cells did not exhibit much evidence of degeneration, but that adenocarcinoma cells and small cell anaplastic cell carcinoma cells did exhibit some appreciable degree of cellular damage. Cytologic examination, however, was capable of identifying whether they were cancer cells or not.In the authors'laboratory, sputum cytology was performed in 39 cases of lung cancer by Saccomanno's concentration method, and comparison between this method and direct smear was studied.The cytolo gically positive rate was elevated by 18.0%, compared with the direct smear in the same specimens.Morphologic characteristics of cancer cells by Saccomanno's concentration method were observed.Epidermoid carcinoma cells were similar to those found by the direct smear.Adenocarcinoma cells were somewhat different from direct smear cells, that is, irregular overlapping of cells was hardly visible, and scattering of cells was increased;thick cytoplasm was common; chromatin was rather coarsely distributed.In small cell anaplastic carcinoma cells, also chromatin distribution was coarse, and cell clumping was more striking.Since this is a rapid, simple method that permits atypical cells to be readily found, 295 people were screened by chest X-ray and sputum cytology using this method.The sputum cytologic tests utilized 3-day pooled collections of spontaneous sputum.At this point, cancer cells have not yet found, though it may be said that the frequency of discovery of histiocytes in these specimens was higher by 18.5% than in the cases where direct smears were employed.