<prompt> Please answer with one of the option in the bracket. Write reasoning in between . Write answer in between .Q:A 60-year-old man comes to the physician because of a 2-month history of chest pain, dry cough, and shortness of breath. He describes two painless masses in his neck, which he says appeared 4 months ago and are progressively increasing in size. During this time, he has had week-long episodes of fever interspersed with 10-day periods of being afebrile. He reports that his clothes have become looser over the past few months. He drinks alcohol occasionally. His temperature is 38C 100.4F, pulse is 90min, and blood pressure is 10560 mm Hg. Physical examination shows two nontender, fixed cervical lymph nodes on either side of the neck, which are approximately 2.2 cm and 4.5 cm in size. The tip of the spleen is palpated 3 cm below the left costal margin. An x-ray of the chest shows discrete widening of the superior mediastinum. Which of the following is most appropriate to confirm the diagnosis?? A: Leukocyte count, B: Fine needle aspiration, C: Sputum polymerase chain reaction test, D: CT scan of the chest, E: Excisional biopsy,  <response>: This appears to be a case of mediastinal lymphadenopathy with systemic symptoms such as fever, weight loss, and splenomegaly. The description of painless neck masses that have been progressively enlarging over 4 months raises suspicion for lymphadenopathy, likely due to a lymphoproliferative disorder or lymphoma. The chest x-ray finding of mediastinal widening supports lymphadenopathy. To confirm the diagnosis, a tissue biopsy is needed, rather than a leukocyte count, sputum test, or CT scan. Fine needle aspiration can obtain tissue but has a high false negative rate in lymphoma. Therefore, an excisional biopsy of one of the palpable cervical lymph nodes is most appropriate to make a definitive diagnosis.E: Excisional biopsy 