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NSCLC staging — SCE Respiratory MCQ

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HardLung CancerNSCLC stagingSCE Respiratory

PET-CT shows FDG-avid ipsilateral mediastinal nodes in a potentially curable NSCLC. Systematic EBUS-TBNA samples the relevant stations but is negative; radiological suspicion remains high and nodal status would change treatment. What should follow?

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Correct answer: B — Consider surgical mediastinal staging before deciding radical treatment

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

E is correct. NICE advises considering surgical mediastinal staging after negative EBUS-TBNA or EUS-FNA when clinical suspicion remains high and nodal status changes management. Negative needle sampling does not completely exclude N2 disease in a high-pretest-probability setting. Repeat PET cannot provide histology, re-biopsying the primary does not resolve nodal stage and unverified PET uptake should not automatically be treated as malignant.

Reference: https://www.nice.org.uk/guidance/ng122/chapter/Diagnosis-and-staging