Correct!
1. Evaluation of the left pleural effusion for metastatic disease
The CT scan shows a left pleural effusion (Figure 2, white arrow) which is worrisome for metastatic disease.
Figure 2. A left pleural effusion is indicated by the arrow.
A tissue diagnosis and an evaluation for metastatic disease are needed. Bronchoscopy might provide a diagnosis but would not evaluate the pleural effusion. There is no evidence of mediastinal lymph nodes on the CT scan and there is no clinical evidence of metastatic bone disease. A left pneumonectomy is not indicated unless the pleural effusion is proven to be benign.
The patient underwent a video-assisted thorascopic (VATS) procedure to assess the pleura and obtain a tissue diagnosis. Pleural nodules were noted and segmentectomy of the mass was performed. Both the primary tumor and the pleural nodules proved to be adenocarcinoma on histology.
Which of the following therapies is least appropriate?