Question

A 68-year-old woman presents with a cough that has been present for the past several months. She describes it as a dry, hacking cough that she attributed to her cigarette smoking. A chest X-ray is completed that shows a 2.5 cm mass in the peripheral right lower lobe. Sputum cytology is performed and is negative for malignant cells. What is the next best step in managing this patient?

a) Order bronchoscopy
b) Refer for transthoracic needle aspiration
c) Repeat chest X-ray in six months
d) Smoking cessation and reassurance

Answer 1

For a persistent cough and lung mass, a referral for transthoracic needle aspiration is the next proper step, aiming to obtain a tissue sample for diagnosis despite negative sputum cytology. Smoking cessation is critical, but diagnostic clarification of the mass is a priority.

Step-by-step explanation:

The next best step in managing a 68-year-old woman with a persistent cough and a 2.5 cm mass in the peripheral right lower lobe, which has been detected on a chest X-ray, and negative sputum cytology, would likely be b) Refer for transthoracic needle aspiration. This procedure is less invasive than a bronchoscopy and can provide a tissue sample for definitive diagnosis. Since the sputum cytology is negative, but a mass is present, further diagnostic testing is warranted to rule out malignancy, despite the absence of malignant cells in the sputum. Additionally, urging smoking cessation is important, but when dealing with a potential lung mass, diagnostic clarification is a priority.

In general, management of cough and possible malignancies involves a step-wise approach to diagnosis and treatment. Smoking cessation is always advised because it can contribute to pulmonary diseases and complicate existing conditions. However, the presence of a lung mass requires prompt attention to determine if it is malignant or benign.