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Lung Mass Investigation — RACP Adult Medicine MCQ

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ModerateRespiratoryLung Mass InvestigationRACP Adult Medicine

A 55-year-old man with known COPD presents with haemoptysis. CT chest shows a 3 cm spiculated mass in the right upper lobe. PET-CT shows intense FDG uptake (SUVmax 12) with no distant metastases. Mediastinal lymph nodes are not enlarged. What is the most appropriate next step?

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Correct answer: B — CT-guided biopsy

A highly FDG-avid spiculated lung mass in a patient with COPD and haemoptysis is very likely malignant. Tissue diagnosis is essential before treatment planning. CT-guided percutaneous biopsy has the highest diagnostic yield for peripheral lung lesions. Bronchoscopy is better for central lesions. EBUS-TBNA is used for mediastinal staging but without enlarged nodes, its yield is low. Direct surgical resection without tissue diagnosis is occasionally considered for high-risk nodules in operable patients who refuse biopsy, but tissue confirmation is standard practice.

Reference: Cancer Council Australia – 2021 – Lung Cancer OCP; TSANZ – 2024 – Lung Cancer Guidelines