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Pulmonology Quiz

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45 yr old presents with a 2.3 cm left upper lobe mass noted on chest x-ray after he presents with 2 months of persistent left sided chest pain. He has a 20 year history of smoking two packs of cigarettes a day. Physical exam is unremarkable. 

CT of the chest reveals an additional non calficied nodule measuring 0.7 cm in the middle right lung. PET/CT scan of the body shows uptake in the left upper lung mass and the right middle lobe mass without other abnormality.  biopsy of both lesion reveals moderately differentiated adenocarcinoma.

PFTs do not preclude surgery.  MRI of the brain is negative. Bronchoscopy shows no endobronchial lesion. A screening colonoscopy done 6 months previously was without abnormality.

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

  1.  Left upper lobectomy and right middle lobectomy with lymphadenectomy
  2.  Platinum based chemotherapy
  3.  Platinum based chemotherapy concurrently with radiation
  4.  Additional evaluation for an occult primary site