Correct!
1. Obtain 18FDG-PET scan
Among the choices listed, 18FDG-PET scanning may be the best choice since two masses are present, and 18FDG-PET may provide data regarding which lesion should preferentially be targeted for intervention or may even disclose additional sites of disease that are more accessible to sampling. Repeating the CT using a specific nodule enhancement protocol would likely not yield management-altering results, although it is possible that one lesion would show enhancement whereas the other may not, directing intervention towards to enhancing nodule. However, because this protocol requires sequential scanning at a single chosen level within the center of the nodule, 4 times at 1-minute intervals, using this protocol to evaluate two separate masses widely spatially separated from one another, is not practical. Surgical lung biopsy remains premature as it is difficult to know which mass should be intervened upon. While bronchoscopy could be entertained, and it is possible to evaluate both masses at the same procedure, further non-invasive characterization would be capable of directing to bronchoscopic procedure more effectively. Thoracic MRI would not provide any information regarding the masses to what is already known with CT.
The patient underwent 18FDG-PET scanning (Figure 3).
Figure 3. 18FDG-PET scan.
Which of the following represents the most accurate assessment of the 18FDG-PET findings? (Click on the correct answer to proceed to the sixth of ten pages)