Correct!
4. Percutaneous transthoracic fine needle aspiration biopsy
All of the choices listed are reasonable, but percutaneous transthoracic fine needle aspiration biopsy is the most appropriate choice among those listed. Follow up thoracic CT to assess for growth is a less optimal choice for management in this circumstance because some of the nodules are fairly large, and follow up thoracic CT to assess for growth is more commonly employed for subcentimeter nodules. 18FFDG-PET scanning may prove useful for evaluation of the nodules in this patient, but the lack of tracer accumulation within the nodules would not preclude the need to establish a diagnosis, and active tracer accumulation within the nodules would add no new diagnostically useful information. If some of the nodules showed tracer accumulation at 18FFDG-PET whereas others did not, it could be argued that tissue sampling should be directed towards the metabolically active lesions, but this approach still leaves tissue sampling as the primary consideration for the next step in management. Bronchoscopy with transbronchial biopsy could be performed, but is less well-suited for establishing the histopathological diagnosis of peripherally located nodules. In contrast, percutaneous transthoracic fine needle aspiration biopsy is highly accurate for establishing the etiology of peripheral pulmonary nodules, particularly when the nodules are larger than 1-1.5 cm.)
Percutaneous fine needle aspiration biopsy and core biopsy of one of one of the nodules was performed and showed fragments of pulmonary parenchyma entrapped within foci of proliferating fusiform cells containing eosinophilic cytoplasm and oval nuclei. Necrosis, mitotic activity, and pleomorphism were not seen.
Immunohistochemical staining showed strong, diffuse nuclear staining for estrogen receptors and diffuse cytoplasmic staining for smooth muscle actin, but no staining for CD10 (a B-lymphocyte marker).
In light of these histopathological findings, among the following choices, which piece of historical information is most useful for establishing the diagnosis for this patient?