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Sarcoidosis PET Misinterpretation — SCE Medical Oncology MCQ

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HardMelanoma & SkinSarcoidosis PET MisinterpretationSCE Medical Oncology

A patient with metastatic melanoma has a sustained partial response to nivolumab at known disease sites but develops new, symmetric FDG-avid bilateral hilar and mediastinal lymphadenopathy. They are clinically well and an EBUS-accessible node is available. What is the most appropriate next step?

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Correct answer: D — Biopsy an accessible mediastinal node before changing systemic therapy

Option D is correct: an accessible node should be biopsied to distinguish sarcoid-like reaction from progression before abandoning effective nivolumab. Option B assumes malignant progression. Option C treats an unconfirmed and asymptomatic toxicity. Option A delays diagnostic clarification, and option E relies on a nonspecific marker rather than tissue.

Reference: Checkpoint-inhibitor sarcoid-like reactions in advanced solid tumours. https://pmc.ncbi.nlm.nih.gov/articles/PMC12065934/