Small persistent GGO post-lobectomy - 1250967

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fran nipponi
Small persistent GGO post-lobectomy - 1250967

Hi, I had a 1.2 cm lepidic-predominant adeno removed 18 months ago. Latest scan newly identified a 4 mm GGO that upon comparison to prior scans has been there since 2010 with minimal change. The report said due to persistence it was suspicious for AAH or AIS and recommended follow-up imaging "at a minimum." To me, whatever it is, it is pretty darn indolent. Is this just a radiologist being very cautious by implying that I might consider doing something more than watch and wait, given the history of prior malignancy? I can't imagine what alternative I have given the small size.

Also, I also had "a number of 2 mm nonspecific nodules in both lungs." No mention if they were present on prior scans. My initial reaction is that everyone probably has tiny spots and only this radiologist chose to point them out, but, again, given my history, how much should I consider that this could be more AIS in its infancy?

As always, thank you.

Reply To: Small persistent GGO post-lobectomy

Hi Fran, I think you're right that the doctors are taking extra care to watch your lungs. I suspect they will keep you on routine scans for at least 5 years until you are officially cured. You're right again that there isn't anything you can do but watch the sub cm nodule. I'm not sure what the radiologist had in mind if it was suggested other than to watch.

As scanning resolutions become better more and smaller nodules will be picked up. What to do about that is still up for debate because they will mostly be benign. But I think since you did have a cancer you will remain under suspicion for another because people who have had one lung cancer have a higher probability of having another than those who haven't.

Good luck and may your lungs stay clear,
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Dr West
Reply To: Small persistent GGO post-lobectomy

I think you're right to distinguish between things that are detectable and things that require intervention. I do think that many of these tiny background nodules in someone with a history of bronchioloalveolar carcinoma (BAC) may turn out to by atypical adenomatous hyperplasia (AAH) or BAC, but I also think that even if so, many of those may grow at a rate that won't be clinically significant for decades, if ever. As for the language used by radiologists in their reports, I would say that a significant amount of the language used is deliberately vague legalese to avoid culpability, and I would remind you that these are people who have no responsibility for or experience with managing the care of patients.

-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