For larger pulmonary nodules (>1 cm) in older smokers, which diagnostic step is commonly performed?

• A. Bronchoscopy
• B. Observation for several years
• C. No testing
• D. Routine antibiotics trial

Answer: (A)

When a patient who smokes and is older has a larger pulmonary nodule, the main goal is to obtain a tissue diagnosis to distinguish malignancy from benign processes and guide treatment. Bronchoscopy allows direct visualization of the airways and enables sampling of lesions that are accessible from the bronchial tree, including transbronchial biopsies, brushings, and washings. It can also sample nearby lymph nodes if needed for staging. This combination provides histology and cytology with relatively lower risk than surgical biopsy, which is why it’s commonly chosen as the diagnostic step for a suspicious nodule in this high-risk group. Delaying tissue diagnosis with observation or empiric antibiotics would miss cancer and delay appropriate management.