Thursday, June 01, 2006

Follow-up to lung nodules

This is the woman with B/L pulmonary nodules. I was also concerned about these non-calcified nodules so she had a PET scan and we performed a bronch. Both nodules lit up on PET and she had some faint, low-SUV uptake in the mediastinal nodes. The TBBx of the R lesion were + for a non-small-cell lung Ca.
She has good PFTs.
What would you do next?

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

Arenberg said...

First, Kudos on getting the lesion on bronchoscopy, that looks like a long shot via bronch, unless you used EMN.

Secondly, I guess I'd do a thoracotomy and take out the one on the LEFT, since you know the one on the right is a cancer, she will need a lobectomy. You do a wedge of the left sided nodule if possible and see what it shows. If its not cancer, you can take the right one out later with a lobectomy. If it is cancer, you can ask your pathologist to estimate on frozen section if it is the same histology.

If the histology is distincly different, you can feel betteer about taking them both out & hope for the best.

AK said...

Would a mediastinoscopy help here? Even if there's not much PET activity there, how likely is it for a neoplasm to metastasize from one side of the lung to the other without seeding the mediastinal nodes in between?

Baleeiro said...

Our plan was the same as that suggested by Doug: since we had tissue from the right and she is a good surgical candidate, she is having a wedge of the L with a med because of the faint nodal uptake. Depending on results from path she may get just a R or a bi-lobectomy. I will post the results after her surgery.