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Pulmonary nodule — SCE Respiratory MCQ

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HardLung cancerPulmonary noduleSCE Respiratory

A 72-year-old woman has an incidental 9 mm solid right upper-lobe pulmonary nodule on CT colonography. She is an ex-smoker, has no previous imaging and is fit for invasive testing if needed. The nodule is mildly spiculated and Brock malignancy risk is calculated at 12%. There is no lymphadenopathy. What is the most appropriate investigation?

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Correct answer: D — PET-CT for further risk stratification

The best answer is “PET-CT for further risk stratification”. PET-CT for further risk stratification 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—“Discharge in the absence of follow-up”, “Immediate lobectomy in the absence of further staging”, “Sputum cytology as the definitive test”, “Treat empirically with antibiotics and repeat in two years”—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: British Thoracic Society pulmonary nodule guideline: https://thorax.bmj.com/content/70/Suppl_2/ii1