Lung nodule growth - 1266886

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missy
Lung nodule growth - 1266886

Hi,
SPN was found on my lung during an abdominal scan.

Linear/nodular density at the periphery of the left lung base measuring up to 9 mm in diameter on prior CT 05/2014
Follow up CT 10/2014
The small density at the base of the left lung on the last exam is increased significantly in size and now measures 1.5 cm x 1.3 cm x .09 cm
Follow up PET 10/2014
Ovoid pleural based left lower lobe lung nodule does not demonstrate any FDG uptake. When measured in a similar fashion, the nodule now measures 1.2 X 1.9 cm compared to approximately 0.9 x 1.5 cm on May 2014. Given the location of this nodule just cephalad to the left hemidiaphragm, percutaneous, CT guided percutaneous biopsy would be extremely difficult. No other significant abnormalities.

While the news is great there is no uptake, I've read there can be false negatives with PET scans. My pulmonologist wants another CT scan in 6 months. My concern is the growth rate. Should it keep growing what are the chances of it being benign? Thank you, any insight would be appreciated!

catdander
It should be a reasonable

It should be a reasonable request to have the CT sooner, in 3 months and insurance or the healthcare system would probably agree. though still likely a benign process if not you'd want to catch a rapidly growing cancer asap and in 3 months it would likely show itself to be so and caught asap.

It's not unusual to have several mm of difference from one scan to another. As a matter of fact there's a study and blog post about it here that suggests the same skilled radiologist can read the same CT scan with mm differences at different times. http://cancergrace.org/lung/2011/08/09/limits-of-ct-scanning/

As I understand it lung cancer usually PET avid at around 1cm.

Good Luck with your follow up,
Janine

Dr West
That location is

That location is unfortunately very difficult for a CT-guided biopsy, which means that the only way to really know what it is may be to do a small surgery to remove the nodule. You're right that the lack of metabolic uptake on PET is favorable, but of course interval growth isn't what we expect to see. Our surgeons would sometimes judge that with progression over a matter of months, a lung nodule should come out. Otherwise, I agree that a shorter interval would be a strong alternative. The fact that it has shown interval growth over 5 months would only lead me to favor a shorter rather than longer interval between subsequent scans if that were the approach selected.

Good luck.

-Dr. West

+++++++++++++++++++++++++
Dr. Howard (Jack) West
Associate Clinical Professor
Medical Oncology
City of Hope Cancer Center
Duarte, CA

Founder & President
Global Resource for Advancing
Cancer Education

missy
Hi Dr. West and Janine,

Hi Dr. West and Janine,
Thanks for the information and responding to my question. What type of small surgery would be done to remove the nodule? What types on benign nodules would grow like this? I will check with my pulmonologist about getting a ct scan earlier.

Thanks again!

Dr West
This would often be a video

This would often be a video-assisted thoracoscopic surgery (VATS) wedge resection to remove the nodule and a little rim of lung around it through a minimally invasive surgery. This is now done by many experienced thoracic surgeons.

Any infection or some forms of inflammation could also appear as a lung nodule.

-Dr. West

+++++++++++++++++++++++++
Dr. Howard (Jack) West
Associate Clinical Professor
Medical Oncology
City of Hope Cancer Center
Duarte, CA

Founder & President
Global Resource for Advancing
Cancer Education

missy
Thanks so much for the info

Thanks so much for the info and quick response!