Summary Cytokinetic parameters of various types of lung cancer were determined in bronchoscopy specimens after in vivo labelling with the thymidine analogue bromodeoxyuridine (BrdU). The S-phase fraction and BrdU labelling index were measured flow cytometrically, allowing calculation of the S-phase transit time and potential tumour doubling time. The methodology used was found to be feasible for obtaining cytokinetic data from 76% of the bronchial biopsy samples.Despite the difference in clinical behaviour and growth pattern between small cell lung cancer (SCLC) and non-small cell lung cancer (NSCLC), no significant differences were observed between the mean values of the cytokinetic parameters of SCLC and NSCLC. The estimated cell loss factor was higher in NSCLC than in SCLC.It appears that the growth of a tumour, as clinically observed, is to a considerable extent influenced by cell loss. In accord with this assumption is the fact that we have observed non-BrdU labelled S-phase cells, both in tumour biopsies and in apparently normal tissue. The presence of these so-called unlabelled S-phase cells in relation to cell loss is discussed.Individual lung cancers differ in histological pattern and other phenotypic characteristics. These differences are relevant in predicting therapeutic responsiveness and prognosis (Fraire et al.,1992). In recent years it has become evidence that in lung cancer as well as in other types of malignancy, cell cycle parameters may be important prognosticators (Tubiana & Courdi, 1989). In several studies, a high S-phase fraction (SPF) was found to be associated with a shorter survival time (Ten Velde et al., 1988;Volm et al., 1985); this was also found for tumours other than lung carcinoma, including breast carcinoma (Kallioniemi et al., 1986;O'Reilly et al., 1990). In addition, a low ex vivo thymidine labelling index in patients with stage I NSCLC predicts a longer survival time (Silvestrini et al., 1991 informed consent, the patients were infused with 50 mg m-2 BrdU (Janssen Pharmaceutica, Beerse, Belgium), dissolved in 100 ml 0.9% NaCI, within a timespan of 10 min. The BrdU was given approximately 4 to 5 h before bronchoscopy. Approval for the in vivo labelling method was given by the ethical committee of the University Hospital of Maastricht. Biopsies were taken with a flexible bronchoscope, fixed in formalin for routine diagnosis and in 70% ethanol for flow cytometric analysis. The latter samples were stored at 4°C until use.
Flow cytometry and BrdU detectionThe biopsy specimens were double-stained with anti-BrdU (clone IIbS; Schutte et al., 1987) and propidium iodide (PI), using the protocol described by Schutte et al. (1987). Briefly, ethanol fixed biopsies were minced in a petri dish and washed twice in phosphate buffered saline (PBS) pH 7.4, by centrifugation for 5 min at 400 g. To obtain nuclei, the cell suspension was digested with 0.4 mg ml-' pepsin (Boehringer Mannheim, Germany; 108057) in 0.1 N HCI for 30 min at room temperature. Undigested fragments were then removed by si...