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Peripheral lung lesion — SCE Respiratory MCQ

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HardLung CancerPeripheral lung lesionSCE Respiratory

A 75-year-old man with severe emphysema has a new 18 mm peripheral left upper-lobe lesion with high PET uptake. Bronchoscopy is normal. The lesion abuts the pleura and there is no mediastinal disease. What is the most appropriate investigation to obtain tissue?

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Correct answer: D — CT-guided percutaneous lung biopsy

The best answer is “CT-guided percutaneous lung biopsy”. CT-guided percutaneous lung biopsy is the investigation that most directly resolves the remaining diagnostic or staging uncertainty at this point in the pathway. The alternatives address different questions, have lower expected yield, or would be premature before this result. The remaining choices—“Repeat bronchoscopy with blind washings”, “Sputum cytology alone, after specialist assessment”, “Pleural aspiration in the setting of no effusion”, “overnight respiratory polygraphy, within a respiratory pathway”—are credible in related respiratory presentations, but each addresses a different diagnostic, staging or management decision and does not fit the decisive findings and pathway position in this stem.

Reference: NICE NG122 lung cancer: diagnosis and management: https://www.nice.org.uk/guidance/ng122/chapter/Recommendations