Journal of thoracic oncology : official publication of the International Association for the Study of Lung Cancer
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The terms pleuroscopy, thoracoscopy, medical thoracoscopy, and video-assisted thoracic surgery are often used interchangeably to describe a minimally invasive procedure that provides access to the pleural space, parietal pleura, lung, and other structures within the thoracic cavity. Pleuroscopy is a more exact term for describing visualization of the pleura and contents of the pleural cavity using an endoscope. This procedure provides physicians a window into the pleural space, to perform biopsy of the parietal pleura under direct visual guidance, particularly for biopsies in cases of exudative effusions with unclear origin, chest tube placement, and pleurodesis to prevent recurrent pleural effusion or pneumothorax in selected patients. In this state-of-the-art review, we discuss the indications, contraindications, and complications of pleuroscopy, and its role in thoracic oncology.
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Accurate staging of lymph node involvement is a critical aspect of the initial management of nonmetastatic non-small cell lung cancer (NSCLC). We sought to determine whether the current N descriptors should be maintained or revised for the next edition of the international lung cancer staging system. ⋯ Current N descriptors should be maintained in the NSCLC staging system. Prospective studies are needed to validate amalgamating lymph node stations into zones and subdividing N descriptors.
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The utility of adjuvant chemotherapy after surgical resection for early-stage non-small cell lung cancer (NSCLC) is now well established. Although a number of randomized clinical trials have demonstrated the efficacy of platinum-based chemotherapy in the overall population treated, subset analysis, excepting Japanese studies, has uniformly shown the greatest efficacy for patients with stage II and III disease and the least benefit for patient with stage I disease. We review data regarding adjuvant therapy of stage I NSCLC from clinical trials performed in North America and Europe. Pertinent trials from Japan are discussed elsewhere in this issue.
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Case Reports
An unusual case of non-small cell lung cancer presenting with renal angle pain and hematuria.
A 53-year-old woman was referred urgently to the urology department with a history of worsening right renal angle pain and associated hematuria. Further investigations revealed the presence of a primary non-small cell lung cancer (NSCLC) invading the posterior chest wall with an associated vaginal metastasis. To our knowledge, this is only the second case report in the literature of a vaginal metastasis from NSCLC.