Hi,

I unfortunately have possible bad news on my first scan (see below report excerpt) which I completed today. RO says it is not conclusive and recommends another CT scan in one month. Hope it is an inflammation. I am wondering if anyone out there has any experience with this.

Excerpt from report:

"There are are several new right-sided pulmonary nodules. A 9-mm right lower lobe pulmonary nodule (axial CT image 68) demonstrates increased FDG uptake, max SUV 2.7. A tiny apical anterior pulmonary nodule also demonstrates faint FDG uptake (axial CT image 50). A third, 6-mm pulmonary nodule in the right middle lobe does not demonstrate abnormal FDG metabolism."

New right pulmonary nodules may represent metastatic or (less
likely) inflammatory process.

Thanks in advance for any suggestion.

Chetan

Um yeah don't sweat it yet or really at all. PET's so close after treatment come up hot all the time, and the uptake on the biggest node is only a 2.7 which is just above what they consider hypermetabolic (2.5). I had a scan 6 months out that came back hot with several spots at 2.8 uptake and the next scan came back clear...that was over 2 years ago.

Also false positives come up on those roughly 1/3 of the time. It's new to you so I remember how difficult it was to get that news and how I felt...now I just brush that off. If the scan comes back hot again in the same spots, get it biopsied and don't believe it's cancer until the pathology report says it is. My money's on false positive.

Keep your chin up

Eric

PETs give reads on inflamation and have a high instance of false positives in general. I'm glad your doctor isn't jumping to any conclusions here.

J's PET lit up in bilateral nodes because of a throat infection. His RO ASSumed it was cancer. He had just started the rad plan of carpet bombing J's head and neck from his nose down to his collarbone...when...voila! No cancer per the 2nd opinion from a CCC. Silly RO...he didn't do a biopsy!

We fired the original docs and hired new ones. Follow-up scan revealed no activity in the nodes that were presumed to be malignant. The inflamation went away.

Hi Eric,

Thanks for your note. It makes me feel better and gives me a reason for hope. I was curious regarding your hotspots that came up six months after treatment. Were they in the lung area or in the H&N area?

Thanks again!

Chetan

Both actually. My lungs lit up due to pnuemonia and my neck and jaw lit up because I was still healing from the mandiblectomy/neck dissection.

Remember all a PET scan does is measure how quickly cells in an area are sucking up sugar(uptake). Healing tissues, immflamation, pneumonia and other conditions can make an area light up and it doesn't have to be cancer. In fact just looking at my records I had an area in my neck that was a 3.2 uptake that was still the swelling from the dissection. My ENT and RO (both I love) told me really not to sweat it too much as that's still a low uptake level that close to treatment.

Hope that helps, and you're most welcome

Eric

Hey chetan! Hopefully everything will be all clear next time around! it's scary to get a result like that - I'm curious because you said it was a ct - was it a ct or a pet? Here they don't use pets very often I think because of the false positives. I'm of two minds about them I think that maybe a year out it's not a bad thing to have one but too early and you're still healing that's when you may have a false positive. Try not to worry. Both machine tend to light up inflammation, infection and cancer... That being the case listen to Eric and sandy... And try not to worry. Some Drs. Can tell by location too. I had a node light up on the opposite side of my cancer - on my - baseline scan post op - they rewrote my plan to include that side in the radiation even though it could have been inflammation or infection (id been in Mexico for a week 5 days prior to the scan!) worried, I talked to my surgeon as well - (frankly I had an issue with my RO not catching the node - I had to ask him about the results and he was non committal - as in - if there was anything to note I would have!!! Then the next day he changes my plan because he actually looked at the scan!!!!!!!!) Anyway my SO said based on the location of the node it's highly unlikely that it was cancerous. I guess they are good at guestimating where it's gonna travel! If you're dr. Isn't worried yet then try not to be. Hugs!! You'll get through this.

Chetan

My personal experience with PETscans is that they miss real oral cancer (false negatives) and show oral cancer where there is none (false positives). The actual numbers are hard to ascertain since radiologists don't follow up with the doctors to gather statistics plus doctors don't gather or report them to anybody. They are especially unreliable for head and neck cancers.
It's for that reason that NCCN guidelines do not include PET scans as part of routine staging, and many institutions use MRI or ultrasound guided biopsies rather than PET scans. The Radiation Therapy Oncology Group (RTOG) utilizes the clinical exam, chest x-ray, and pre-treatment CT scan as their standard workup but not Petscans
However a recent retroscpective study shows Petscans may be very good for lymph node cancer detection and have the potential to significantly reduce unnecessary neck dissections
Charm

The PET I recently had was to check my lyph node which did light up and a needle biopsy did confirm cancer. The PET also covered my lungs and showed spots lighting up. The largest was needle biopsied but was inconclusive because only one of the three attempts at getting useful tissue was succesful. That tissue sample came up negative for cancer.

We ar now following up with a series of CT scans over time to see if tht spot changes in any wat. Had a CT on it today.

Chetan- not good news but not necessarily bad news either.

If it were me - I would, as you are, be concerned. If these were my results, these are a few things that might cross my mind: That the radiologist classiflies these as "new" suggests that there are earlier scans of the lungs to compare to - but making assumptions is never a good idea! Do you KNOW that there are older scans that they are comparing the new scans to? If so, the "new" results would be a little more worrisome because it suggests that they weren't there before. Have you had pneumonia in the past few months? Have you had any potential aspiration in the past few months? If so, that could be the culprit. If not, then the appearance in the lungs is suspicious- one would expect the hot spots to be in the head/neck area rather than than lungs where it doesn't sound you were radiated.

All that being said, the risk of a false positive is high, as others have pointed out.

If there aren't actually older scans to compare to then it might potentially be the result of old pneumonia scars or perhaps some chronic pulmonary issues that you may have suffered earlier in life, or many other things you may have gotten into your lungs over your life to date!
I know from earlier posts that your are a rational, clinically minded person - my intention is to give you a few thoughts to consider as you sort things out and make it through the next few weeks when more assessment is planned.
The site mantra seems to be "it's not cancer till a pathology report says it's cancer" - hold that in your mind until you know for sure.

Hang in there!

Hi Charm, Eric, Jennifer, Kelly

Thanks very much for your responses and your perspectives, which gives me reason for hope.

We met with the RO yesterday and he went over the PET/CT scans with us. He recommended I wait for a month, scan again and then decide. The waiting game is difficult. Kelly referred me to someone at MDA and I will get in touch with the hope of keeping them in the loop.

Thanks again for your responses and support!

Best Regards,
Chetan