Friday, May 12, 2006

Lung cancer and adenopathy

A reader submitted this question:
A patient was just diagnosed with lung cancer and will be undergoing surgery soon. The tumor was discovered during an incidental Cxray and is approx 2.5 cm and located in the right lower lobe. We were encouraged to find that the ct scan showed no spread to the the lymph nodes and no pleural effusion. However, a subsequent PET scan showed bilateral Hilar uptake but no mediastinal uptake. The Thoracic surgeon scheduled a medianoscopy before the lobectomy just to make sure there was no spread of the cancer to the lymph nodes. His feeling is that the PET scan would have shown some mediastinal uptake on the PET scan and feels that the bilateral Hilar uptake is probably not cancer.
Just wanted to get some other views on this situation.

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

Baleeiro said...

I would not discount the PET. Indeed, +nodes are not the same as a confirmed tissue specimen but are concerning enough. I agree with your surgeon that node sampling before the lobectomy is the way to go.

Jeff H said...

I agree. I would want the lymph nodes sampled; it's the difference between T2NO stage 1B and T2N3 stage 3B, and would therefore have a profound impact on prognosis and management.

Anonymous said...

I bet it's not cancer. T2 N3 in the absence of mediastinal nodes stretches the imagination.

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