Related Experiment Video
Updated: Jun 8, 2026

Thoracoscopic Extended Right Middle Plus Lower Sleeve Lobectomy for Non-Small-Cell Lung Cancer
Published on: February 27, 2026
Visceral pleural invasion classification in non-small cell lung cancer
Akikazu Kawase1, Junji Yoshida, Genichiro Ishii
1Division of Thoracic Surgery, National Cancer Center Hospital East, National Cancer Center Hospital East, Kashiwa, Chiba, Japan.
Objective:
We analyzed non-small cell lung cancer patient survival in our single institution database to evaluate the effect of visceral pleural invasion (VPI) on survival and to propose a method of incorporating VPI into T-status classification in future staging systems.
Methods:
We reviewed 2725 consecutive surgically resected non-small cell lung cancer patients with T1a, T1b, T2a, T2b, or T3 tumors for their clinicopathologic characteristics and prognoses. Visceral pleural invasion was classified using the criteria of the 7th edition of the TNM Classification for Lung and Pleural Tumors.
Results:
There were no significant differences in survival between PL1 and PL2 patients. Therefore, we decided to combine the PL1 and PL2 patient groups into a single VPI+ group, and compare survival with a PL0 (VPI-) group to analyze the effect of VPI on T classification. The best survival was observed in patients with a T1a/VPI- tumor, followed by those with a T1b/VPI- tumor. In comparison, survival was similarly worse among patients with a T1a/VPI+, T1b/VPI+, T2a/VPI-, or T2b/VPI- tumor. The worst survival was observed in patients with a T2a/VPI+, T2b/VPI+ or T3 tumor.
Conclusions:
Otherwise T2 tumors with VPI, regardless of size, may be classified as T3 tumors in the next edition of the TNM Classification for Lung and Pleural Tumors.
Related Concept Videos
Pleural Disorders: Types and Brief Description
Pleura of the Lungs
Pleural Effusion I: Introduction
There are two main types of pleural effusion: transudative and exudative. They are differentiated using Light's criteria,...
Pneumothorax II: Pathophysiology
Pleural Effusion II: Symptoms and Management
A pleural effusion is the abnormal collection of fluid between the parietal and visceral pleura layers of tissue that form the lining of the lungs and chest cavity. It can occur independently or due to surrounding parenchymal diseases, such as infection, malignancy, or inflammatory conditions.
Clinical Manifestations:
Pulmonary Tuberculosis III
The first classification is based on the development of the disease, and it includes the following categories:
