A 57 year old recently retired demolitions worker complains of increasing shoness of breath. The patient was a chronic heavy cigarette smoker through his adult life but quit about a year before presentation. A chest CT was performed.Which of the following steps is not appropriate in the evaluation of this patient?

A. PA chest radiograph shows a large mass in the left upper lobe (arrow). B. Coronal contrast-enhanced CT study shows a left upper lobe lung mass (arrow). C. Axial CT study shows a left upper lobe lung mass (white arrow) and enlarged mediasintal lymph nodes (black arrow). D. Axial CT study shows multiple liver masses (arrows) Answer: (d), follow-up CT in 3 to 6 months to document stability of the lesion is not an appropriate next step in evaluation of this patient, and thus (d) is the correct answer. Positron emission tomography (PET scan) is an appropriate next step, which would be expected to show hypermetabolism in the lesion as well as any metastatic deposits, and thus (a) is not the correct answer. Bronchoscopy with sampling of the lesion is an appropriate next step, and therefore (b) is not the correct answer. Computed tomography directed biopsy of the lesion is also an appropriate next step, and thus (d) is not the correct answer.