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Pulmonology Quiz

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45 yr old presents with a 2.3 cm peripheral non calcified left upper lobe mass. He has a 30 year history of smoking 1 to 2 packs of cigarettes a day. Physical exam is unremarkable.

CT of the chest reveals no evidence of mediastinal lymphadenopathy. MRI of the brain with gadolinium is unremarkable. PFTs reveal an FEV1 of 3.1 liters. Bronchoscopy shows no invasion of the trachea, carina or vocal cord paralysis. Biopsies are inconclusive. PET/CT scan show uptake in the left upper lobe mass with no evidence of regional lymphadenopathy or metastatic disease.

The patient undergoes left upper lobe wedge resection. Pathology shows non small cell lung cancer, adenocarcinoma favored. One of the margins returns as positive. All sampled lymph nodes are negative.

Of the following options, the next best step in the management of this patient is:

  1.  Repeat limited resection or lobectomy
  2.  Concurrent chemoradiation
  3.  Definitive radiation
  4.  Adjuvant chemotherapy