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Mediastinal staging in lung cancer — SCE Respiratory MCQ

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HardLung CancerMediastinal staging in lung cancerSCE Respiratory

A 61-year-old smoker has a central right hilar mass and enlarged subcarinal node on CT. Bronchoscopy shows extrinsic compression but no visible endobronchial tumour. PET-CT shows FDG uptake in the subcarinal node and no distant disease. What is the most appropriate investigation?

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Correct answer: D — Endobronchial ultrasound-guided transbronchial needle aspiration

EBUS-TBNA is the appropriate minimally invasive way to sample FDG-avid mediastinal nodes and obtain diagnosis and stage. CT-guided peripheral biopsy is poorly targeted when the abnormality is central nodal disease. Thoracotomy without tissue and staging would be inappropriate.

Reference: NICE NG122; BTS Bronchoscopy guidance