A 68-year-old man with locally advanced non-small-cell lung cancer is evaluated because of the new onset of low back pain over the past 2 weeks. It is relieved with ibuprofen, and his only other symptom is mild fatigue. The patient completed combined chemotherapy and radiation therapy 6 months ago, and restaging scans afterward showed marked shrinkage of the right perihilar mass. He has no muscle weakness. Plain radiograph of the thoracic and lumbar spine shows no abnormalities other than signs of mild osteoarthritis. Neurologic examination is unremarkable. What is the most appropriate next step in the management of this patient?

Question

Quizplus · Accepted Answer

Given the patient's history of non-small-cell lung cancer and new onset of back pain, an MRI of the spine is the most appropriate next step to evaluate for possible metastatic disease to the spine, even in the absence of neurological symptoms or abnormalities on plain radiographs.

A 68-Year-Old Man with Locally Advanced Non-Small-Cell Lung Cancer Is