What is the best approach to get a sample of a 2cm lung nodule in the left upper lobe anteriorly located. There is left Hilar node involvment confirmed by CT and PET with suv of 6.7 in the hilar and 3.5 in the nodule. Margines are irregular and nodule is non calcified. I have images from ct and pet. Patient history 14 pack year smoking , heavy marijuana use for 10 years, 27 yr old female with extensive family history of cancer on mothers side. Grandmother and aunt both passed of lung cancer that took over . Would you be suspicous of malignancy? Ct said inflamation or infection but 2 month follow up to rule out neoplasm . Pet report left it more open to all three innflamation/ infection/ cannot rule out malignancy.
The best way to have proper diagnosis is FNAC from the lung nodule. The aspiration fluid should also take for the test for culture and sensitivity and especially for fungal infections.  The management will depend on the result. Depending on the history you have given it may be fungal infection which is difficult to diagnosis and treatment.  This is not same with cancer. Diagnosis is nowadays is easy and have treatment options especially in early stages. If the diagnosis is not established with FNAC then another way is biopsy,- done by radiologists or surgical oncologists and pulmonologist.