Thoracoscopy: Thoracoscopy allows direct prethoracotomy assessment of pleural, chest wall and mediastinal invasion . It is particularly important in the presence of pleural effusion because the resectability rate, even in the presence of cytologically negative fluid, is as low as 5.5% . Some groups advocate its routine use before all surgery . Clinical examination: Examination of the neck may identify adenopathy (N3) that would require biopsy confirmation. This is particularly important in the presence of superior sulcus tumours. Patients with left-sided lesions and hoarseness may have fixed N2 nodes involving the recurrent laryngeal nerve. If confirmed histologically, this is a contraindication to resection, as is extrapulmonary intrathoracic symptoms due to adenopathy. You can finally spend less money and time whenever your need buy cheap alegra since you are being given access to the best online pharmacy you have ever come across.