Wednesday, June 29, 2005

Follow-up to pulmonary nodule

I posted this a while ago: this is the 77 y/o woman, non-smoker but extensive second-hand smoke exposure with the pulmonary nodule found on pre-op eval for a TKR.
She has had her TKR and is doing very well. She returned today after her PET scan:
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?

7 comments - CLICK HERE to read & add your own!:

Jennings said...

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...

Pixelation said...
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Mendez said...

I would also follow with serial CTs. Can you order nodule protocol CT? They can do extra cuts through the nodule to look for calcification.

Mike L said...

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?

Jennings said...

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).

Baleeiro said...

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.

Mendez said...

Cases that I've had like this - I have followed per the usual protocol 3, 6, 12, 24. JJ's point is well taken -- at this point we're only looking for slow growing malignancy anyway. However, I don't beleive there are any formal guidelines for this specific situation - therefore I believe following with the usual serial follow up timeline is appropriate.