American Board of Internal Medicine (ABIM) Certification Practice Exam

How is a solitary pulmonary nodule treated when staging shows a high likelihood of malignancy?

1. Only observation

2. Immediate aggressive chemotherapy

3. Surgical excision

4. Referral for clinical trials

The correct answer is: Surgical excision

In the context of a solitary pulmonary nodule that has been staged and shows a high likelihood of malignancy, surgical excision is the most appropriate and definitive treatment option. This approach allows for direct removal of the nodule, which provides not only treatment but also the opportunity for pathological examination, leading to a definitive diagnosis. If the nodule is malignant, surgical excision can help remove the tumor entirely, which is critical for local control and potentially improving survival outcomes. Observation alone is generally not suitable for nodules with a high suspicion of cancer, as delaying intervention could allow the tumor to grow and spread, worsening the patient’s prognosis. Immediate aggressive chemotherapy is not typically the first-line approach for early-stage lung cancer unless there are specific indications such as advanced disease or poor surgical candidacy. Referring patients for clinical trials can be an option, but surgical excision remains the standard of care for nodules staged as likely malignant, especially in early-stage lung cancer scenarios. Thus, surgical excision aligns with the principles of managing high-risk solitary pulmonary nodules effectively.