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Pancoast tumour — SCE Respiratory MCQ

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HardLung cancerPancoast tumourSCE Respiratory

A 67-year-old smoker has shoulder pain radiating down the medial forearm, ptosis and miosis. CT chest shows a right apical lung mass abutting the first rib with suspected brachial plexus involvement. Spirometry is acceptable for potential radical treatment and there is no distant disease on staging CT. The MDT wants to assess local resectability. What is the most appropriate investigation?

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Correct answer: A — MRI thoracic inlet and brachial plexus

The best answer is “MRI thoracic inlet and brachial plexus”. MRI thoracic inlet and brachial plexus 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 plain chest radiograph in six weeks”, “Diagnostic thoracentesis before staging”, “Ventilation-perfusion scan as the next test”, “Empirical radiotherapy in the absence of tissue diagnosis”—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