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Suspected lung cancer with pleural effusion — SCE Respiratory MCQ

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HardThoracic ImagingSuspected lung cancer with pleural effusionSCE Respiratory

A 76-year-old man with COPD has a CT performed for haemoptysis. It shows a 2.8 cm spiculated right lower lobe nodule, enlarged subcarinal lymph node and a small ipsilateral pleural effusion. Pleural ultrasound confirms a safe pocket. What is the most appropriate investigation?

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Correct answer: D — Diagnostic thoracentesis for cytology

When a pleural effusion is present in suspected lung cancer, pleural aspiration is a low-risk way to establish diagnosis and stage disease as M1a if malignant. CT-guided or bronchoscopic biopsy may be needed later but would not address pleural staging. Short-interval surveillance is inappropriate for a suspicious spiculated mass with nodal disease.

Reference: NICE NG122 Lung cancer; BTS Pleural Disease Guideline 2023