Superior sulcus tumour — SCE Respiratory MCQ

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HardLung CancerSuperior sulcus tumourSCE Respiratory

A 55-year-old man has shoulder pain radiating to the ulnar forearm, ptosis and hand weakness. CT shows a right apical lung mass invading the chest wall. PET-CT shows no distant metastases. What is the most appropriate investigation?

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Correct answer: C — MRI thoracic inlet/brachial plexus for local staging

The best answer is “MRI thoracic inlet/brachial plexus for local staging”. MRI thoracic inlet/brachial plexus for local staging 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—“D-dimer testing, with clinical reassessment”, “Pleural aspiration in the setting of no effusion”, “Peak flow monitoring, after safety review”, “Serum calcium as the definitive staging test”—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