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Pulmonary Nodule — SCE Medical Oncology MCQ

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HardLung CancerPulmonary NoduleSCE Medical Oncology

A 12 mm solid upper-lobe pulmonary nodule has a Brock malignancy risk of 15% and is above the local PET detection threshold. PET-CT shows moderate uptake. What should happen next under the BTS pathway?

Educational content. Not a substitute for clinical judgement or local policy.

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Correct answer: A — Apply the Herder model using qualitative FDG uptake, then act on the revised malignancy probability

Explanation lettering: B = shown as A · D = shown as B · A = shown as D

B is correct. Brock risk above 10% triggers PET-CT when the nodule is large enough for reliable assessment; PET uptake is then incorporated into the Herder model. After that reassessment, less than 10% generally favours CT surveillance, 10–70% prompts consideration of image-guided biopsy with alternatives individualised, and above 70% favours definitive treatment in a suitable patient. A 15% Brock score is not itself a lobectomy threshold. Moderate uptake is informative but neither diagnostic nor reassuring enough to discharge, and repeating Brock without incorporating PET discards the purpose of the second test.

Reference: BTS pulmonary nodule guideline: https://www.brit-thoracic.org.uk/clinical-resources/guidelines/pulmonary-nodules/