Previous studies indicate that upper airway (UA) sensory receptors play a role in the maintenance of UA patency and contribute to arousal in response to airway occlusion. An impairment of UA sensory function could therefore predispose to UA obstruction during sleep. We hypothesized that UA sensation is impaired in obstructive sleep apnea (OSA), and that sensation improves after treatment with nasal continuous positive airway pressure (CPAP). We measured two-point discrimination (2PD) and vibratory sensation thresholds (VT) in 37 patients with OSA (mean [+/- SE] apnea- hypopnea index [AHI] = 39 +/- 5 events/h), 12 nonapneic snorers (SN), and 15 control subjects (CL). Sensory thresholds were determined in the UA and on the lip and hand as control sites. Both 2PD and VT were similar among the three groups at the lip and hand sites but were significantly reduced in the UA of OSA and SN subjects versus CL (p < 0.05). Values for 2PD and VT in the UA of OSA versus SN were not significantly different. Sensory measures were repeated after 6 mo in 23 OSA patients treated with CPAP as well as in 18 untreated patients. Thresholds for 2PD and VT at control sites remained identical in both groups, as did 2PD for the UA. However, VT in the UA showed a significant improvement in treated (4.4 +/- 0.2 pre-CPAP versus 3.8 +/- 0.2 mm post-CPAP, p < 0.05) but not untreated patients. These findings indicate the presence of a selective impairment in the detection of mechanical stimuli in the UA of patients with OSA and SN, which is partially reversible after treatment with nasal CPAP in patients with OSA.

Advances in molecular biology are improving the understanding of lung cancer and changing the approach to treatment. A satisfactory biopsy that allows for histologic characterization and mutation analysis is becoming increasingly important. Most patients with lung cancer are diagnosed at an advanced stage, and diagnosis is often based on a small biopsy or cytology specimen. Here, we review the techniques available for making a diagnosis of lung cancer, including bronchoscopy, ultrasound-guided bronchoscopy, mediastinoscopy, transthoracic needle aspiration, thoracentesis, and medical thoracoscopy. We also discuss the indications, complications, and tissue yields of those techniques, especially as they pertain to testing for molecular markers. KEY WORDSLung cancer, diagnosis, bronchoscopy, endobronchial ultrasonography, thoracoscopy, transthoracic needle aspiration, molecular markers, EGFR INTRODUCTIONDiscoveries in molecular biology are changing the approach to the treatment of patients with non-smallcell lung cancer (nsclc). In recent years, the histologic characterization of lung cancer has markedly advanced, moving beyond the simple distinction of small-cell or non-small-cell disease.The observation that certain histologic subtypes respond differently to particular chemotherapeutic agents and the increasing use of targeted therapies have created a need for precise histologic characterization of biopsy specimens. For example, several trials have shown that response rate and survival with pemetrexed are significantly better in patients with non-squamous histology [1][2][3] . Trials using tyrosine kinase inhibitors have observed that greater benefit from treatment with those agents is seen in patients with nsclc tumours harbouring EGFR mutations than in patients with wild-type tumours 4 . Ongoing clinical trials are examining the use of Alk inhibitors in patients with nsclc characterized by EML4-ALK gene translocations 5 . Those mutations are found almost exclusively in adenocarcinomas.Lung cancer remains the leading cause of cancer death in North America. In Canada in 2010, an estimated 25,300 Canadians were diagnosed with lung cancer, and 20,600 died of the disease 6 . At diagnosis, 75% of patients have either locally advanced or metastatic disease 7 . The goal in this latter group of patients is to establish the diagnosis and, ideally, to confirm the disease stage with the least invasive technique possible. As a result, biopsy specimens have become increasingly smaller. Of nsclc patients receiving chemotherapy for advanced disease, 80% will have only a small biopsy specimen or cytology samples available for diagnosis 8 .In this review, we discuss the minimally invasive and invasive techniques available for the diagnosis and staging of lung cancer, with their success rates and complications. We also discuss the size of the tissue samples obtained by the various techniques, as that size pertains to maximizing the histologic characterization of lung cancer in an era of personalized medicine. Lastly, we re...