Difference Between CT and PET/CT Reports - 1245724

chebird
Posts:104

Dear Faculty,

I am very confused as to the difference in a CT verses a PET/CT report.

When a PET/CT says that a mass has resolved, does that mean it can still be there but dead? My husband's latest CT scan showed a 5x3x2 mass-like plural thickening which was unchanged from a CT scan done last October, but in two PET/CTs done in between the CT scans (1/12, 4/12) the wording was that the tumor had resolved. The oncologist used the word "stable" today, and we thought the cancer was gone.

10/11 CT 5x3x2 cm
1/12 PET/CT tumor resolved
3/12 PET/CT tumor resolved
7/12 CT 5x3x2 cm

I didn't read the scan report until after I got home. I called, but could only talk to a nurse, so hence the panic and the inquiry here.

So, my question is, is it usual for a PET/CT to say a tumor is gone, but the tumor still shows up on a CT?

Thank you so much for what you do here at Grace!

Blessings,

Holly

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Reply # - July 23, 2012, 04:00 PM

Dr West
Posts: 4735

No, I think resolved implies that there is no tumor. Otherwise, it should say that it's present but not "PET-avid" or "hypermetabolic", which would suggest that there's something there that isn't likely to be viable cancer.

It's fair to ask for clarification here.

-Dr. West

Reply # - September 28, 2012, 07:49 PM

chebird
Posts: 104

Well, the mystery has been solved.

We went to Banner MD Anderson in Gilbert on Monday, and the oncologist showed us the questionable PET/CT scans. The tumor is most definitely there on the CT part of the scan. Obviously, whoever wrote the radiology reports only looked at the PET part. There was wording such as "Tumor has resolved" on the first scan, and "The apical mass has resolved and there is no evidence for tumor recurrence", on the second PET/CT scan.

So, for six months we happily assumed there was NED. The Banner oncologist told us he has a 5% chance of surviving another four years. She said there's no way to know if the tumor is dead or not; more than likely, the Tarceva is just keeping it at bay.

He goes to work everyday, and besides being tired in the evenings from the Tarceva, a person wouldn't know he was sick.

That makes four out of seven of his scans that have been misread or mis-reported. We live in a rural area, and every scan goes to the same people to read. Scary stuff. How trustworthy are most radiology reports? He has another CT scheduled for next week. How can I trust that what is reported is accurate?

Blessings to all,

Holly

Reply # - September 29, 2012, 02:39 AM

certain spring
Posts: 762

Just wanted to sympathise - it is awful when you lose trust in the people who are supposed to be looking after you. I would be spitting tacks and feeling entirely powerless at the same time. I suppose the obvious response would be to switch hospitals, but it sounds as if you can't easily do that.
Can you point out the discrepancy and see how your regular hospital responds? Is it feasible to ask for the scans to be sent elsewhere to be read? Or cross-checked?
I can see that it's very upsetting and destabilising to have the ground shifting under your feet like this. But it is still the case that your husband is doing amazingly well. (Hurrah for the Tarceva.) Hope you and he can hang onto that knowledge. Very best.

Reply # - September 29, 2012, 07:23 AM

chebird
Posts: 104

Thank you very much, Certain Spring.

There is no cancer hospital in this county; we go to a one-onc clinic. The next appt is in a few weeks. I am going to ask him exactly the questions you posed. If we are not happy with the answers, we will move my husband's treatment to Banner MD Anderson. It's far, but doable.

Actually, if that monster comes to life again, we plan on doing this anyway. Oh, oh. Now I'm back to, "How would we know?".

And you are so right about Tarceva. I thank God for it every day.

So, I have to ask. Your bio says squamous, yet you tested EGFR pos? Or did your cancer mutate?

Holly

Reply # - September 29, 2012, 08:58 AM

Dr West
Posts: 4735

certain spring actually is a relatively uncommon case of a person with a squamous cancer that harbors an EGFR mutation. They are seen in fewer than 5% of squamous NSCLC patients, but it's definitely some.

I don't have an easy answer to the "how do we know if our docs are trustworthy?" question. There is definitely variability in the skill level in and degree of meticulous attention from different radiologists and other doctors. One indicator that would probably be helpful is to ask someone you do trust, such as the docs at Banner, who have reviewed his situation and records, whether they feel that it's perfectly good to pursue care closer to home or whether they wouldn't honestly recommend that someone in their own family receive care at your local center.

Good luck.

-Dr. West

Reply # - September 30, 2012, 11:31 AM

chebird
Posts: 104

Thank you so much, Dr. West.

The oncologist at Banner said our Dr up here is doing exactly what she would do; Tarceva and wait and watch.

Your site is such a blessing.

Holly

Reply # - October 15, 2012, 07:46 PM

chebird
Posts: 104

Dear GRACE,

Now, this is something different. CT scan done on 10/03/12: "Again seen is left apical pleuroparenchymal scarring." Huh? Scarring? This has never been mentioned.

My question is, does the tissue change so that after some time (like a year) the radiologist MD can discern scar tissue? A few weeks back, the Banner oncologist said there was no way to tell. We are afraid to be excited, especially with my husband's history of scans being misread.

God bless,

Holly

Reply # - October 15, 2012, 09:50 PM

Dr West
Posts: 4735

It sounds like a different radiologist just used different terminology to describe a stable finding. I don't want to speculate about what is happening. It just sounds like the person reading the scan sees stable abnormal findings that are being attributed to a "post-treatment effect" -- essentially scarring. It's very common for different doctors to just use different terms for the same findings.

-Dr. West

Reply # - October 16, 2012, 07:11 AM

catdander
Posts:

Oh Holly that's great news! I think y'all can get excited that he's had another stable scan. And I know y'all must be excited that he is working and has practically no side effects. I wish for you both that someday no treatment will yield the same results. In reality I know how cautious you feel you must stay for fear of such a big let down. Sometimes I think I've turned my intellect off and live fantastically. If that makes any since.

Janine

Reply # - October 16, 2012, 04:51 PM

chebird
Posts: 104

Thanks so much to you both!

Dr. West,

What you said makes perfect sense (as usual), and Janine thanks for the positive reply! Living in the fantasy of a cured husband is certainly enticing!

Blessings,

Holly

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