28th February 2025

A 58-year-old man has been admitted with 4 weeks of gradually progressive dyspnoea

A 58-year-old man has been admitted with 4 weeks of gradually progressive dyspnoea, cough with green phlegm and weight loss. He is an ex-smoker of 15/day for 20 years.

He has a past medical history of mild COPD and hypertension. He uses a Trelegy Ellipta inhaler with occasional salbutamol. He works as a brick layer and can usually walk 3 miles without rest.

His saturations are 96% on room air, and other observations are normal. His GP prescribes doxycycline. An urgent chest X-ray shows a right middle zone mass. He is referred on the urgent two-week-wait for lung cancer pathway.

A CT of his chest, abdomen and pelvis identifies a centrally located 2.8 cm right-sided middle lobe mass but no lymphadenopathy. His routine blood tests are satisfactory apart from improving inflammatory markers following antibiotics. He has no CT evidence of distant metastasis or deposits elsewhere in the thorax. A bone scan confirms no bony metastases. He undergoes bronchoscopy and biopsy, which confirms squamous cell carcinoma of the lung. He is discussed in the lung cancer MDT.

What is the most important additional test for this man to be considered for possible surgical management?

Select the SINGLE most appropriate option from the list below. Select ONE option only.