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EBUS Staging — SCE Medical Oncology MCQ

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HardLung CancerEBUS StagingSCE Medical Oncology

A potentially operable NSCLC has a strongly FDG-avid 4R node measuring 14 mm. Systematic EBUS-TBNA samples 4R, 7 and 11R adequately but finds no malignancy. Nodal status would determine surgery versus definitive chemoradiotherapy. What is the next step?

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Correct answer: C — Consider surgical mediastinal staging because high pre-test suspicion persists despite negative endosonography

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

B is correct. NICE recommends systematic EBUS-TBNA or EUS-FNA for PET-positive or enlarged intrathoracic nodes, but negative endosonography does not exclude disease when pre-test probability remains high. Because the 4R result changes curative treatment selection, surgical staging should be considered before the MDT commits to resection or chemoradiotherapy. EBUS negative predictive value is context dependent, PET has false positives and cannot assign N2 histology alone, and an immediate repeat PET is not pathological confirmation.

Reference: NICE NG122 lung-cancer diagnosis and staging: https://www.nice.org.uk/guidance/ng122/chapter/Diagnosis-and-staging