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Mediastinal staging — SCE Respiratory MCQ

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HardLung cancerMediastinal stagingSCE Respiratory

A biopsy-proven apical NSCLC causes severe shoulder pain, Horner syndrome and C8 weakness. CT suggests extension through the superior sulcus, and curative multimodality treatment remains possible. Which imaging best defines local resectability?

Educational content. Not a substitute for clinical judgement or local policy.

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Correct answer: B — MRI of the thoracic inlet and brachial plexus

Explanation lettering: E = shown as A · A = shown as B · B = shown as C · C = shown as E

A is correct. NICE specifically recommends MRI when needed to assess the extent of superior sulcus tumours. It delineates brachial plexus, neural foraminal, vertebral and vascular involvement that determines resectability. Chest radiography, V/Q imaging, cranial CT and isolated subcarinal EBUS do not map the local thoracic-inlet anatomy.

Reference: https://www.nice.org.uk/guidance/ng122/chapter/Diagnosis-and-staging