Your 54-year-old male patient is undergoing evaluation for dyspnea. He is a lifelong nonsmoker. A CT scan was performed by his primary care physician and a 2.5cm RUL lesion with spiculated border is noted, with a 1.4cm satellite nodule in the same lobe of the lung. There is a 7mm subcarinal lymph node seen, but no other lymph nodes or nodules are seen.
He undergoes PET scan which reveals hypermetabolism in both upper lobe nodules, but the subcarinal lymph node is not hypermetabolic.
What additional evaluation should be done?
What do you recommend regarding bronchoscopy? Surgery? SPN CHEST