Wednesday, February 08, 2006

Follow-up to the 83 y/o with abnormal CT scan

This is the 83 y/o man with an abnormal CT scan sent to us by the CT surgeons. This posting had generated some nice discussion on how to approach these octogenarians.
His bronch was non-diagnostic and his PET was actually negative (very low uptake to the mass). We did a repeat CT scan 3 months after the original one and the lesion is unchanged: no calcification, no improvement. He is asymptomatic... What would you do next?

See answer below.

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

Jennings said...

Either follow q 3 mos or resect - both are reasonable; it depends on what patient wants.

Baleeiro said...

Would you have it resected now with a negative PET an negative bronch?

Jennings said...

I guess that even if it was a neoplasm, the negative PET suggests that the tumor has a low-metabolic rate and thus slow-growing. So repeating a ct every 3 months would be the way I would go, if the patient wasn't too anxious and was agreeable.

Jeff H said...

I generally agree. I would offer the patient both options (repeat imaging or surgery) and proceed with whatever approach allows the patient to feel comfortable. If the can not live with the possibility that there is a potentially growing, but undiagnosed malignancy, than I would advocate surgery. If they can accept the uncertainty and would like to avoid surgery, than I would follow it radiographically.

Baleeiro said...

Despite the negative PET, I recommended the same options as the Jeffs.
He underwent a wedge biopsy, extended to a lobectomy when the frozen path was positive for a NSCLCa with one positive N1 node.
(final path should be back today)