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Suspected lung cancer with mediastinal nodes — RACP Adult Medicine MCQ

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ModerateRespiratorySuspected lung cancer with mediastinal nodesRACP Adult Medicine

A 66-year-old man with a 45-pack-year smoking history has weight loss and haemoptysis. CT chest shows a 3.2 cm right upper lobe mass and enlarged right paratracheal nodes. He is potentially fit for curative treatment. What is the most appropriate investigation?

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Correct answer: A — PET-CT with tissue sampling of mediastinal nodes, usually by EBUS-TBNA

Potentially curable lung cancer requires staging and tissue diagnosis, and EBUS-guided nodal sampling is appropriate when mediastinal nodes are present. Sputum cytology alone is insufficient for staging and modern molecular work-up. Empirical radiotherapy, delayed radiography or asthma assessment would be inappropriate.

Reference: Cancer Australia lung cancer guidance; TSANZ; eTG