She has had her TKR and is doing very well. She returned today after her PET scan:
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Her Pet was negative and she has had no other symptoms. Would you even bother to follow her up to see if the nodule calcifies or would you be happy with the negative PET?
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Well,she's a nonsmoker and bronchoalveolar cancer can present as a solitary nodule (and is PET negative). I had a case like that at the VA a few years ago - it took a few years for the nodule to grow and it was ultimately diagnosed as BAC.
I might follow the nodule with occassional CT's to make sure it is not growing. Now, if there was some nice central calcification you would of course not need to follow that.
Also, carcinoid (again nonsmoker) can present this way but I guess if this thing isn't in the airway, it's less likely...
These are the kind of cases that always make me nervous. Like JJ, I had a patient with a stable xray for a full year before an astute radiologist picked up a subtle enlargement of the nodule. Turned out to be BAC.
I almost want to make the surgeons take all of them out; however, I would then operate on too many patients with non-malignant disease.
I would definitely f/u the nodule with CT scans.
What is everyone's protocol on how long will to continue to get f/u scans?
How frequently do you repeat scans?
Well, they say 3 months as you know, but in this particular patient I would maybe do 3 mos, then 6 months, then a year later (because of the pre-test probability and negative PET - you are essentially floowing CT's for BAC which grow slower anyway).
I get the same cold feet with these nodules. She is coming back in 3 months with a CT scan and from there I will space it out and follow for at least 2 years total.
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