You have a 60 yo male patient being evaluated for a cough of two month’s duration. He is an active smoker with a 45 pk year smoking history. He reports increased dyspnea on exertion and right chest heaviness and discomfort. You perform a screening CT scan on him as he meets lung cancer screening guidelines, and CT reveals a 5cm spiculated RUL mass with distal collapse of the RUL. There is also a small to moderate right pleural effusion and irregularity of the right pleural surface.
You use an spn calculator to help you determine the probability that this is lung cancer and guide your discussions with this patient.
Based on the probability this is lung cancer and based on what information you currently have, which of the following regarding lung cancer staging in this patient is most true?
1) T stage is T3
2) If the pleura was not involved this would be IB
3) M stage is M1
4) Staging cannot be determined without biopsy of the mediastinal lymph nodes
What procedure would you perform to confirm the diagnosis and staging?