Recurrence pattern and rapid intraoperative detection of carcinoembryonic antigen (CEA) mRNA in pleural lavage in patients with non-small cell lung cancer (NSCLC).

A positive finding on intraoperative pleural lavage cytology (PLC) is considered a possible prognostic factor in patients non-small cell lung cancers (NSCLCs). Patients negative for cancer cells on PLC, however, have occasionally developed recurrence after surgery. In this study, we evaluated the significance of the rapid intraoperative detection of carcinoembryonic antigen-mRNA(mCEA) in pleural lavage in patients with NSCLCs for detecting subclinical recurrence. In 298 NSCLC patients, PLC and mCEA expression of the cell fraction in pleural lavage fluids was analyzed immediately after thoracotomy. The results of mCEA detection by the transcription reverse transcription concerted (TRC) quantitative method and PLC with reference to clinicopathologic characteristics and recurrence patterns were analyzed. The TRC analysis was completed within 90 minutes. Eighty-seven patients (30.9%) were mCEA-positive, and 8(2.7%) were PLC-positive and all mCEA-positive. The positive mCEA rates were not significantly associated with histology or the serum CEA level. Patients with positive the mCEA results showed higher recurrence rates than the mCEA-negative group (5-11%). Thus, intraoperative mCEA analysis by the TRC method should be considered as a sensitive aid to assessing the microscopic spread of malignant cells into the pleural cavity in association with recurrence.