Are nodules located in pleura more concerning? - 1294882

Sun, 07/15/2018 - 08:34

I had a lobectomy (RUL) two years ago for moderately aggressive adenocarcinoma stage 1a. My recent CT scan showed a 6mm solid non - calcified pleural nodule in the LEFT lower lobe which was not present in previous scans with most recent scan being 6 months ago. No infiltrate or pleural effusion present. There are also two small fissural nodules which are unchanged for 2 years.

6mm is small and I would not typically be overly concerned but the pleural location makes me wonder about metastasis. I will be having another scan in 3 months. I have read articles indicating that pleural nodules are frequently metastasis.

Thank you so much for any information you may provide.

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onthemark

Hi Debbie,

Welcome back to GRACE. I hope this turns out to be a benign or transient lesion.

I'm not aware of a single pleural nodule, in the absence of other signs of pleural disease, to be more likely to be metastasis than a single nodule in the lung tissue itself. Can you share a reference for one of the articles you read?

onthemark

I think the fact that you don't have a pleural effusion, or more than one new or growing nodule anywhere in the scan is a good sign. It isn't necessarily a tumour at this point, but a lesion on a ct scan.

My impression, which could be wrong, is that metastatic cancer involving the pleura typically presents as a diffuse nodular disease rather than a single lesion. How does the radiologist describe the lesion and what is his/her overall impression?

debbie57

Yes, I think no effusion is a good sign, too. I don't know if one lesion is as concerning as diffuse. I know I'll have to wait to see what happens in the next 3 months (waiting is the worst part) but I just like to be as educated as possible so I know what questions to ask.

The only description on the report was: posterior left lower lobe 6mm nodule not present previously - no infiltrate or effusion. My pulmonologist said it is solid and non-calcified. He was upbeat but said it needed to be watched carefully. The radiologist recommended a short term CT scan.There was nothing about shape, spiculated, etc.

catdander

Hi Debbie,

I hope it's a transient infection and gone next scan. Waiting is awful.

Keep us posted,
Janine

onthemark

Thanks Debbie,

I'm not seeing where the radiologist wrote it was in the pleura, or abutting it? or close to it??

JimC

Hi Debbie,

The distinction between a metastatic pleura nodule and one which is not metastatic is determined by how it got there. If cancer cells spread to the bloodstream or lymph system, then a nodule is metastatic. But as Dr. Weiss has said:

“Invasion of pleura alone does not make lung cancer stage IV. Invasion of visceral pleura makes NSCLC T2. Invasion of the chest wall or mediastinal pleura makes NSCLC T3. This would be stage II or III then, depending on nodes. Things that make a cancer stage IV are distant spread or malignant pleural effusion (fluid on the lung that contains cancer cells).” - http://cancergrace.org/forums/index.php?topic=7328.0

So if the lung tumor abuts the chest wall or mediastinal pleura, it is likely to have directly invaded the pleura rather than having cancer cells in the bloodstream.

JimC
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debbie57

On the mark,

I just didn't mention the location when paraphrasing the radiologist report.

Thanks for your help, and take care!

Jim,

I have had a hard time finding much information about pleural nodules and the little bit I found discussed metastatic cancer. I feel more at ease when I understand what is happening and what the next steps would be if the nodule does grow in the next three months.

I very much appreciate everyone's help!

Debbie