Correct!
2. Bronchoscopy

The CT scan is most consistent with an endobronchial obstruction in the right lower lobe. Bronchoscopy would be the easiest procedure to make a diagnosis. Needle biopsy of the lung or brain or VATS are more invasive. Chemotherapy is not appropriate because no tissue diagnosis has been make. Bronchoscopy was performed along with endobronchial ultrasound (EBUS, Figure 4).

Figure 4. Panel A: bronchoscopic view of RLL bronchus showing narrowing and mucosal abnormality. Panel B: EBUS showing enlarged interlobar lymph nodes. Panel C: location of lymph nodes.

Biopsy of the bronchial mucosa was nondiagnostic but the EBUS-directed lymph node aspiration was consistent with adenocarcinoma or non-small cell lung cancer (NSCLC, Figure 5).

Figure 5. Papanicolaou smear of lymph node aspirate consistent with adenocarcinoma or NSCC.

Which of the following therapies is not true regarding NSCLC brain metastasis? (Click on the correct answer to proceed to the sixth and final panel)

1. Metastatic brain tumors that are epidermal growth factor receptor (EGFR) positive will respond to EGFR tyrosine kinase inhibitors such as gefitinib or erlotinib
2. Metastatic brain tumors that have 4-anaplastic lymphoma kinase (ALK) translocations will respond to crizotinib
3. Prophylactic brain radiation has not been shown to be beneficial in NSCLC
4. Stereotactic radiosurgery should be considered in those with 1-4 brain metastases
5. Surgical resection should be considered in those with solitary brain metastasis

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