OpenOnco · Workup Brief · DIAGNOSTIC PHASE

Pre-tumor-board workup brief

DPLAN-PZ-DIAG-SCLC-001-V1 · v1 · 2026-05-13

Patient

PZ-DIAG-SCLC-001 · suspicion lineage: small_cell_lung_carcinoma

Tissues: lung, right_main_bronchus, mediastinum · Hypotheses: DIS-SCLC

71M heavy smoker (62 pack-years, current) presents with 6-week progressive cough + 4 kg weight loss + new-onset confusion + fatigue. Labs: Na 124 mEq/L (hyponatremia, baseline 138 6 months ago). Serum osmolality 268, urine osmolality 580, urine Na 65 → SIADH pattern. CXR: 5.8 cm right_perihilar_mass with bulky mediastinal LAD. CT chest: central_lung_mass invading right main bronchus + mediastinal LAD (4R + 7 stations) + bilateral hilar LAD + small right pleural effusion. No bone/liver mets on CT (need PET-CT). LDH 612 (elevated). Imaging + paraneoplastic_siadh in heavy smoker strongly suspicious for small_cell_lung_cancer (SCLC has higher SIADH association than NSCLC).

Workup steps (8)

1imaging Contrast-Enhanced CT Chest/Abdomen/Pelvis
Initial staging imaging для більшості hematologic malignancies — лімфаденопатія mapping, organomegaly, extranodal involvement. Часто replaced by PET-CT для definitive lymphoma staging, але CECT доступnoша для початкового workup.
2lab Complete Blood Count with Differential
Baseline cytopenia assessment and ongoing monitoring of myelosuppression.
3lab Comprehensive Metabolic Panel
Електроліти (Na, K, Cl, HCO3), креатиnoн + BUN (renal function), глюкоза, кальцій, альбумін, total protein. Базова метаболічна оцінка перед будь-якою терапією + основа TLS risk + dosing adjustments.
4lab Liver Function Tests
Assess hepatic function — baseline + during BR cycles + DAA therapy + HBV reactivation monitoring.
5lab Lactate Dehydrogenase
Tumor burden surrogate; rising LDH suggests transformation or progression in indolent lymphoma.
6histology Flexible bronchoscopy with EBUS-TBNA
Tissue sampling of central lung lesions and mediastinal lymph nodes for both diagnosis and N-staging in NSCLC and SCLC. Preferred for central tumors and N1/N2 nodes.
7other Brain MRI with contrast
8imaging FDG PET/CT
Staging at diagnosis + response assessment after antiviral or chemoimmunotherapy. Detects transformation hotspots.

MDT brief

MDT talk tree (3 steps)

#	Owner	Topic	Action
1	pathologist	Specialist review	Any suspicion requires biopsy — pathologist plans site selection, IHC panel, ancillary tests.
2	radiologist	Specialist review	Stage / restaging imaging + biopsy guidance — radiologist.
3	surgical_oncologist	Specialist review	Suspected solid tumor — resectability assessment, biopsy approach.

Skills (required) — mandatory virtual specialists (2)

Pathologist (general) required
Any suspicion requires biopsy — pathologist plans site selection, IHC panel, ancillary tests.
Radiologist required
Stage / restaging imaging + biopsy guidance — radiologist.

Skills (recommended) — for consideration (1)

Surgical oncologist recommended
Suspected solid tumor — resectability assessment, biopsy approach.

Technical MDT skill metadata (3/16 activated in this plan)

All registered virtual specialists. ✓ — activated for this case; ○ — not activated (available for other clinical scenarios).

Specialist	skill_id	Version	Last reviewed	Domain
Cellular therapy specialist (CAR-T)	`cellular_therapy_specialist`	v0.1.0	2026-04-25	cellular_therapy
Clinical pharmacist	`clinical_pharmacist`	v0.1.0	2026-04-25	clinical_pharmacy
Hematologist / oncohematologist	`hematologist`	v0.1.0	2026-04-25	hematology_oncology
Hematopathologist (lymphoma / leukemia / myeloma)	`hematopathologist`	v0.1.0	2026-04-25	hematopathology
Infectious disease / hepatology	`infectious_disease_hepatology`	v0.1.0	2026-04-25	infectious_diseases
Medical oncologist (solid-tumor chemotherapist)	`medical_oncologist`	v0.1.0	2026-04-25	solid_oncology
Molecular geneticist / molecular oncologist	`molecular_geneticist`	v0.1.0	2026-04-25	molecular_oncology
Palliative care	`palliative_care`	v0.1.0	2026-04-25	palliative_care
Pathologist (general)	`pathologist`	v0.1.0	2026-04-25	pathology
Primary care / family physician	`primary_care`	v0.1.0	2026-04-25	primary_care
Psycho-oncologist	`psychologist`	v0.1.0	2026-04-25	psychosocial
Radiation oncologist	`radiation_oncologist`	v0.1.0	2026-04-25	radiation_oncology
Radiologist	`radiologist`	v0.1.0	2026-04-25	diagnostic_imaging
Social worker / case manager	`social_worker_case_manager`	v0.1.0	2026-04-25	psychosocial
Surgical oncologist	`surgical_oncologist`	v0.1.0	2026-04-25	surgical_oncology
Transplant specialist (BMT)	`transplant_specialist`	v0.1.0	2026-04-25	cellular_therapy

plan_id: DPLAN-PZ-DIAG-SCLC-001-V1 | version: 1 | generated: 2026-05-13T10:01:53.123778+00:00

Per FDA non-device CDS positioning (CHARTER §15): Diagnostic-phase MDT support: structure the workup, identify the team, surface unresolved questions. Not a medical device; not a treatment plan.

Per FDA non-device CDS positioning (CHARTER §15): DIAGNOSTIC PHASE — this output describes diagnostic workup only. Treatment plan generation is blocked until histology is confirmed (CHARTER §15.2 C7). Do not treat on suspicion.

This document is an informational resource supporting tumor-board discussion (per CHARTER §11). It is not a system that makes clinical decisions. Every recommendation must be verified by the treating physician.