Identifying lymph node involvement with VATs surgery - 1295137


After VATs wedge surgery for a 1a Squamous nodule in my RLL, the oncology surgeon said that he couldn't find any lymph nodes to biopsy. The pathology report said the tumor abuts the pleura, but doesn't infiltrate into it. Surgical resection margins were free of tumor. The tumor had been poorly differentiated, and there was evidence of lympho-vascular invasion.

I believe that the surgeon was saying that there can be areas of the lung where there are no lymph nodes. I know he said that he really spent a long time poking around trying to find some. How would this work with staging?


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Hi atrooper,

Although it might be good to seek clarification from the surgeon, I think your assumption is correct, that there simply weren't any lymph nodes near the resected nodule. In the absence of any evidence of enlarged nodes or other indications the cancer has spread, it seems likely the original Ia staging would remain unchanged.

And that's a great result!

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Met with radiologist. They said given the indolent nature not sure radiation would benefit me much and they suggested regular scans. With covid, iI decided to wait and just have scans. Couple of years have now passed and nodule has not grown although it does still show a small solid component. New nodule, appeared 9mm on 10/24/2022 scan. Says could just be atrelectasis but they want to increase scans to every three months or do pet scans. Waiting to hear from Doctor, but interesting how in past new nodules would just appear and I would keep the regular 6-12 month scan checkup bu tnow he is sugestingscans but now the report says ot

JanineT GRACE …
Posts: 628
GRACE Community Outreach Team

So good to hear from you Jim! I had to go back and refresh myself on your long BAC journey. You are no stranger to seeking input from oncologists who specialize in BAC. I wonder if it's time for another consult. Most everyone does virtual consults now.


I wouldn't want to guess at why your doc is moving up your scan schedule but it would make sense to want to keep an eye on something new by sticking in an extra scan.  Keep us posted and I hope you are otherwise doing well. 


All the best,


I joined GRACE as a caregiver for my husband who had a Pancoast tumor, NSCLC stage III in 2009. He had curative chemo/rads then it was believed he had a recurrence in the spine/oligometastasis that was radiated. He's 10 years out from treatment.