Correct!
5. CT-guided percutaneous lung biopsy
Given the history of urinary malignancy and the appearance of a new indeterminate lung nodule, short-term follow up CT, usually obtained to assess for growth as a proxy for aggressiveness, is not appropriate. Similarly, 18FDG-PET scan would not provide management-altering results negative 18FDG-PET results (highly unlikely) would be difficult to reconcile with the clinical situation, and positive 18FDG-PET results would prompt a tissue diagnosis, so a tissue diagnosis is required regardless. Bronchoscopy with transbronchial biopsy is not inappropriate, but probably stands a lower chance than percutaneous transthoracic needle biopsy. Cryobiopsy is generally reserved for evaluation of diffuse lung disease and not used to evaluate pulmonary nodules.
The patient’s warfarin was held and he underwent percutaneous transthoracic lung biopsy (Figure 3).
Figure 3. Axial unenhanced chest CT performed during percutaneous transthoracic needle biopsy. Note that the nodule has enlarged (now 3.9 cm) only 22 days after the presentation chest CT (2.8 cm, Figure 2).
Histopathological analysis showed poorly defined adenocarcinoma with necrosis consistent with urothelial malignancy, showing a morphology identical to the patient’s bladder malignancy. Repeat CT of the abdomen and pelvis showed post-surgical changes related to left renal and adrenal resection and ureteral resection and cystectomy with ileal conduit information, but no evidence to suggest recurrence of malignancy.
Which of the following represents an appropriate next step for the patient’s management? (Click on the correct answer to be directed to the eighth of fourteen pages)