American Board of Internal Medicine (ABIM) Certification Practice Exam

Which method is the least invasive for confirming lung cancer diagnosis while aiding in staging?

1. Bronchoscopy with biopsy

2. Needle aspiration of supraclavicular lymph nodes

3. Open lung biopsy

4. CT-guided needle biopsy of the lung

The correct answer is: Needle aspiration of supraclavicular lymph nodes

The least invasive method for confirming a lung cancer diagnosis while also aiding in staging is through needle aspiration of supraclavicular lymph nodes. In cases of lung cancer, the presence of metastatic disease in the supraclavicular lymph nodes is a critical factor for staging. By aspirating these nodes, a clinician can obtain diagnostic tissue with minimal trauma to the patient. Needle aspiration of supraclavicular lymph nodes is performed with local anesthesia and does not require a surgical incision, making it less invasive compared to other methods like open lung biopsy, which involves a more significant surgical procedure and would generally require anesthesia and hospitalization. This method not only helps in diagnosing lung cancer but also provides valuable information about disease staging, as it can indicate the presence of metastasis. In contrast, bronchoscopy with biopsy involves navigating the airways with a flexible tube and may require sedation, which, while still relatively minimally invasive, is more complex than a needle aspiration. An open lung biopsy is a much more invasive surgical approach that entails making a larger incision in the chest and poses higher risks and recovery times. CT-guided needle biopsy of the lung, while also minimally invasive, still carries more risk than supraclavicular lymph node aspiration and typically requires imaging guidance, which