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Systemic sclerosis-associated ILD — SCE Respiratory MCQ

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HardInterstitial Lung DiseaseSystemic sclerosis-associated ILDSCE Respiratory

A 14 mm solid pulmonary nodule has a calculated Brock malignancy risk of 18%. There is no previous imaging and the patient would be fit for curative treatment. What is the next BTS risk-stratification step?

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Correct answer: D — FDG PET-CT followed by Herder risk calculation

For a pulmonary nodule at least 8 mm or 300 mm3 with Brock risk above 10%, BTS recommends FDG PET-CT when the nodule is above local PET detection threshold, followed by reassessment with the Herder model. The updated risk then guides CT surveillance, biopsy or treatment. The alternative scores address pulmonary embolism, pneumonia or pleural infection.

Reference: BTS guideline for investigation and management of pulmonary nodules (Published 2015): https://thorax.bmj.com/content/70/Suppl_2/ii1; BTS pulmonary-nodule guideline resources (Published 2015; current BTS resource): https://www.brit-thoracic.org.uk/quality-improvement/guidelines/pulmonary-nodules/