Should patients with anal canal SCC undergo an FNA biopsy of any palpable inguinal LN that is also FDG avid on PET/CT or should these nodes be assumed to be positive and treated to a higher dose?

Even though PET/CT can be falsely positive in the inguinal region, in the era of IMRT we treat all metabolically positive node with the presumption that it is disease. Would not necessarily rely on FNA as this could be a sampling error. Since therapeutic dose can be delivered safely, I would err on ...