Molecular biomarker testing of advanced‐stage NSCLC is now considered standard of care and part of the diagnostic algorithm to identify subsets of patients for molecular‐targeted treatment. Tumour tissue biopsy is essential for an accurate initial diagnosis, determination of the histological subtype and for molecular testing. With the increasing use of small biopsies and cytological specimens for diagnosis and the need to identify an increasing number of predictive biomarkers, proper management of the limited amount of sampling materials available is important. Many patients with advanced NSCLC do not have enough tissue for molecular testing and/or do not have a biopsy‐amenable lesion and/or do not want to go through a repeat biopsy given the potential risks. Molecular testing can be difficult or impossible if the sparse material from very small biopsy specimens has already been exhausted for routine diagnostic purposes. A limited diagnostic workup is recommended to preserve sufficient tissue for biomarker testing. In addition, tumour biopsies are limited by tumour heterogeneity, particularly in the setting of disease resistance, and thus may yield false‐negative results. Hence, there have been considerable efforts to determine if liquid biopsy in which molecular alterations can be non‐invasively identified in plasma cell‐free ctDNA, a potential surrogate for the entire tumour genome, can overcome the issues with tissue biopsies and replace the need for the latter.

Previous pleural endoscopy is considered to be a relative contraindication to further medical thoracoscopy. We reviewed our experience in patients undergoing more than one thoracoscopy irrespective of the primary indication. From January 2001 to December 2006, patient baseline characteristics, endoscopic appearance and technique, volume of pleural fluid and final histological diagnosis were collated in all patients undergoing more than one thoracoscopy. The endpoints were morbidity and mortality related to the procedures, to compare the length of procedure time between pleural endoscopies in individual patients and the degree of difficulty of the second or subsequent thoracoscopic procedure. During this period, 29 patients underwent 'redo' thoracoscopy resulting in a total of 61 procedures (rate of 'redo' thoracoscopy; 9.1%). The mean time between thoracoscopies was 5.3+/-3.8 months. Although pleural adhesions were more common at the time of the subsequent procedure, it did not result in failure to induce a pneumothorax or perform the procedure. There was no difference in the duration of procedure between the primary and subsequent thoracoscopy (P=0.46), as well as no complications directly attributed to the repeat pleural endoscopy. Repeat medical thoracoscopy is technically feasible in patients with pleural disease without an associated increased morbidity and mortality.

they ''rarely'' had difficulty. The different experience may reflect a difference between elective or semi-elective postoperative admissions versus acute medical admissions. Perceived or actual experience in intensive care could be another factor; 48% of respiratory specialist registrars had experience of intensive care medicine at the SHO level compared with 100% of anaesthetic trainees, and all the anaesthetic trainees had experience at the registrar level compared with 52% of the respiratory specialist registrars. Both groups underestimated the duration of critical care experience of each other. Critical care leads considered that the ''quality'' of referral was better from specialist registrars in anaesthesia than medicine. They strongly supported the need for physicians to receive more training in how to make effective referrals and in achieving a more ''realistic'' understanding of potential benefit from ICU admission. Our survey confirms the common perception that medical teams have more difficulty than anaesthetic colleagues in gaining acceptance of their patients to intensive care. Furthermore, this may relate to the perception that they are less able to judge need or prognosis because they have less ICU experience. Critical care training is soon to be integrated into acute care common stem, 2 but additional experience for all medical specialties is probably needed together with an expansion of dual accreditation by medical specialists in intensive care medicine.

This retrospective series demonstrates that early chest drain removal post diagnostic thoracoscopy is possible and safe. This is likely to confer economic benefits.

using "breast cancer" and "national cancer database" and another using "lung cancer" and "national cancer database." The data was combined to determine each variables' association with journal impact factor using both univariate and multivariate analyses. P< 0.05 was considered as statistically significant. Results: A total of 191 published studies were identified. We found that a journal impact factor > 5 was associated with a publication year prior to 2017 (univariate analysis OR 2.68, 95% CI 1.38-5.21, p-value 0.004 and multivariate analysis OR 3.47, 95% CI 1.62-7.42, p-value 0.001) and a sample size > 10,000 (univariate analysis OR 3.27, 95% CI 1.43-7.50, p-value 0.005 and multivariate analysis OR 4.68, 95% CI 1.89-11.6, p-value 0.0008). Variables such as number of authors (5 vs. >5), region (US vs. non-US), cancer type (lung vs. breast), stage (including vs. excluding stage IV), treatment outcome (yes vs. no) and treatment incidence (yes vs. no) were not significant for an association with an impact factor > 5. Conclusion: Based on our data, studies published after 2017 using the NCDB were associated with a lower impact factor. This could suggest that the quality of the NCDB data may be declining over time. References: