Pulmonary cytologic examination in the identification of the second primary carcinoma of the lung

Multiple primary carcinomas of the lung were histologically confirmed in 23 male patients. Five were synchronous neoplasms. Seventeen of the second pulmonary cancers originated in the contralateral lung. The major cell type was epidermoid (17/23), and in 11 patients the tumor was similar in histologic features to the first lesion. Examination of pulmonary secretions as a diagnostic aid in the identification of the second malignant neoplasm was employed for 73.9% (17/23) of the patients. With a single exception, these were obtained at the second diagnostic hospitalization rather than as an outpatient monitoring procedure. Only nine patients had a series of cytologic preparations consisting of three consecutive early morning sputa, bronchial washings/brushings, and a postbronchoscopy sputum. A cytodiagnosis of cancer was established in 82.4% (14/17) of the cases and preceded histologic verification in ten. Radiologic evidence of a second primary was noted in only 56.5% (13/23) of the patients. Pulmonary cytologic examination as a monitoring procedure was not employed in the outpatient follow-up for 64 patients surviving pulmonary cancer for 18 months or longer. Posttherapeutic studies were obtained on 39.1% (25/64) of the hospitalized patients. Thirty-two percent (8/25) were collected concurrently with tissue biopsies for the confirmation of recurrence or metastasis. Patients with primary pulmonary cancers resected for cure should be monitored on a regular basis to include the cytologic examination of three consecutive early morning sputa and a chest radiograph.