A 60 year old man is suspected of having bronchogenic ca: TB has been ruled out in this pt. What should be the next investigation
Correct Answer: Bronchoscopy and biopsy
Description: Answer is B (Bronchoscopy and biopsy) : Fibreoptic bronchoscopy with a brochial or transbronchial biopsy is the better option here as it also allows direct visualization of the tumor mass 'The screening of lung cancer by means of sputum cytology & chest radiographs is not very effective'-H1401/255 Once signs/symptoms or screening studies suggest a diagnosis of bronchogenic carcinoma it is necessary to establish a tissue diagnosis of malignancy. From the options provided tumor tissues can be obtained by a bronchial or transbronchial biopsy during fibreoptic bronchoscopy or CT guided FNAC. Fibreoptic bronchoscopy is the preferred initial investigation to obtain a tissue diagnosis. Approach to diagnosis The first investigation while investigating a case of haemoptysis: should be 'X-Ray chest'. Once X-Ray chest suggests bronchogenic carcinoma (i.e. suspected mass) the next investigation should be Bronchoscopy An HR-CT should be done only if bronchoscopy is negative. In this question we already suspect the diagnosis of bronchogenic carcinoma. The investigation protocol, therefore expects us to proceed fuher from this point, hence a bronchoscopy should be the next investigation. HRCT and guided FNAC is done only if bronchoscopy is negative. As TB has already been ruled out sputum cytology is not the investigation to be done.
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