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Pulmonary Nodule — RACP Adult Medicine MCQ

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HardRespiratoryPulmonary NoduleRACP Adult Medicine

A 62-year-old man with a 10 mm solid pulmonary nodule found incidentally on CT chest is a lifelong non-smoker. PET-CT shows no FDG avidity. Previous CT 12 months ago showed the nodule was 8 mm. What is the most appropriate next step?

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Correct answer: A — CT-guided biopsy

A growing solid nodule (8 mm to 10 mm over 12 months) in any patient warrants tissue diagnosis regardless of PET avidity. PET-CT has limited sensitivity for lesions <10 mm and for low-grade malignancies (e.g., adenocarcinoma in situ). CT-guided biopsy or surgical excision is the next step. MDT discussion is appropriate.

Reference: eTG Respiratory – 2024 – Pulmonary Nodule; BTS 2015 Pulmonary Nodule Guidelines