False negatives? - 1263605

Hi Sara,

It's not that needle biopsies are unreliable, but for various reasons they don't always determine for certain whether a nodule is cancer. You may find Dr. West's post on false negatives helpful: http://cancergrace.org/lung/2012/04/22/false-neg-biopsies-of-lung-nodul…

I'm certain that in making his recommendation your doctor is taking all of the relevant factors in your situation into account, all of which you have identified - growth of the nodule and the PET results. As Dr. West has said:

"It’s definitely very possible to have a false negative biopsy, and I can certainly understand that when the findings are very suggestive of cancer, an inconclusive biopsy doesn’t dissuade us from suspecting cancer, particularly if an alternative explanation isn’t offered, such as finding an infection or auto-immune process, etc." - http://cancergrace.org/topic/fathers-lung-cancer-diagnosis#post-1253861

In the same thread, Dr. Pinder added:

"The challenge is that certainly a concerning finding on imaging can look convincingly like a cancer, but not be cancer. A biopsy in these situations is very helpful if cancer is found, or if another diagnosis (like an obvious infection) is identified. If a biopsy does not show cancer or another diagnosis, this does not mean that cancer is not necessarily present; it could just be that the needle did not capture the cancer cells. A tumor is generally made up of a mixture of living and dead cells, and a biopsy needle is not a 100% guarantee of making the diagnosis.

The same issue can be the case for a lymph node in any location, and a possible lymph node certainly needs to be taken into account in the decisions about observation or treatments."

JimC
Forum moderator

Jim provided a valuable summary of the key points. Given the growth, uptake on PET, and other nodules, I think it's very reasonable to not presume that the negative biopsy ends the matter, so further workup is a strong consideration, particularly if that wouldn't require a lobectomy.

-Dr. West

Hi Dr. West and Everyone,

I also had a biopsy this week on one of my ground glass opacities. My first CT Scan was in December of 2010 where they found five of these between my two lungs ranging in size from 1mm to 8 mm. This CT Scan was followed up with one in March 2011, September 2011, February 2012, February 2013 and then April 2014. My pulmonologist was worried about the 8mm one because it was large enough to cause me issues while I was still young in my life if it grew. This year in April 2014 it was noted that the 8mm nodule grew 2mm over the period from March 2011 - April 2014 and it grew a solid part to it. It was decided that I should have a bronchoscopy biopsy. I was under full anesthesia and it was completed. This was at a very reputable hospital and I was told they got samples all the way around it and in it. My procedure did not cause me a lot of discomfort besides the hoarse/sore throat and now a slight stitch in my upper back on my left side which I believe will go away in a day or two.

I also met with a surgeon to talk about removing this nodule. It is in the upper left lobe but way deep into the lung so I would have to have the entire upper left lobe removed. My pulmonologist called me with the results last night and the biopsies came back showing no cancer. That said it was a mixed blessing because there was not another cause for what it is and why it grew the 2 mm over three years. My brother died of adenocarcino of the lung and I smoked from a young age but quit over 15 years ago so considered to be high risk for this type of cancer. I have read all of your great articles Dr. West over the last four years and my gut tells me to not jump in so quick and wait 3 months for another CT Scan while concurrently taking the stress tests for surgery. That said any articles to read or ideas would be welcome. Giving up one lobe of my lung for something that is not conclusive seems wrong. All insight is welcome. Thanks.

Hi vegas, I'm sorry you're worrying over this and I can certainly understand it. The following blog post will give some insight into why waiting is thought to be a good decision when talking about a 2mm growth in 3 years. http://cancergrace.org/lung/2011/08/09/limits-of-ct-scanning/

I hope this is helpful,
Janine

I wish I could offer a good answer. Because it's impossible to say whether a negative biopsy is a false negative or a true one except in retrospect, and because I and the other faculty become involved only after a cancer diagnosis has been made, we really can't go down the rabbit hole of working up every concerning finding that doesn't have a cancer diagnosis.

I know you're thinking about all of the right things. If you don't have cancer, I'll be nothing but delighted that you won't need our services. And if you do, we will absolutely offer all of the education and support we can.

Good luck.

-Dr. West

Thanks Janine and Dr. West,
The article was insightful. Thanks for providing all of the wonderful resources on this site :))