Friday, November 04, 2005

Approach to this lesion

A physician wants some feedback regarding how to approach this lesion. This is an abdominal CT. A chest CT has not yet been done. The quesion regarding approach: get a PET? Go right to CT-guided biopsy? Get a full CT of chest first in case soemthign shows up that would make a bronch more helpful?
He's a patient with COPD and heavy smoking history. Abd CT was obtained b/c of some nausea.

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

Mendez said...

I think a CT chest would make sense at this point - a negative PET wouldn't rule non-FDG avid malignincies.

On the image, there appear to be two lesions (the obvious peripheral lesion with rib invasion-looks like it's parenchymal in orgin based upon its margins) and ?noncalcified RML nodule.

The CT would help identify any other lesions and guide procedures that could help in terms of staging. I also think that a concurrent CT guided Bx (he'll be in the scanner anyway) of the peripheral mass makes sens.

Baleeiro said...

I'd also get a dedicated chest CT to better define adenopathy and other lesions that may warrant a bronch even rather than a CT Bx.

Jeff H said...

I'd get a chest CT first. A biopsy of the posterior lesion that seems to be invading the chest wall would, if it is a primary lung malignancy, mean this is a T3 lesion at best. If the 2ng lesion is also a malignancy, it would mean that this is metastatic or two primaries.

I dedicated CT, if there are mediastinal nodes, would direct the biopsy toward those nodes. If the CT scan does not show any LAD, than I'd consider a PET scan, and preferentially biopsy the PET+ lesion (if one of the two are PET+).

Also, PFT's should be done. If there are no nodes, and only one of these lesions is malignant, than a resection (involving chest wall if necessary) would be possible.

Arenberg said...

Agre with above...to evaluate a chest mass (or multiple masses), you must have a complete picture of the mediastinum and lung windows. ONce you have this, a PET scan can be used to determine the best site to biopsy.