Friday, November 03, 2006

preop stage

I thought this was an interesting case because it involves role and possible limitations of PET scanning for staging prior to surgical resection. A 69 year old presented with a LUL mass. The bronch brushings revealed non-small cell lung cancer. A PET showed the intense uptake in that mass:

The PET was otherwise negative except for some mild hypermetabolic activity in the right hilar and pericarinal regions corresponding to nonenlarged lymph nodes on CT:

Because of this, he underwent LUL lobectomy. However, an ipsilateral mediastinal node was positive. I do not think they sampled the area of the hilum that lit up (it was contralateral), so in this case the PET did not indicate that he had spread. Also of interest, the margins from resected mass were negative.

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

Anonymous said...

What's the next step for this patient?

Jennings said...

he is getting chemo.

Arenberg said...

This is pretty common, and its not a bad thing that this patient underwent a lobectomy to prove he/she had stage IIIa disease. Not all IIIa is created equal, and a so called minimal stage IIIa like this patiennt had is best treated with post-operative chemotherapy, but the addition of post-operative radiation is a bit controversial.

The surprise mediastinal LNs are not a surprise when your remind yourself of the low sensitivity of PET to detect lesions that are under 10 mm in size.

Mike L said...

At our hospital, the surgeons use the PET and CT with each other to determine the need to sample mediastinal nodes.
For example, if the PET OR the CT scan show lymph nodes in the mediastinum (irrespective of size), the surgeons do a mediastinoscopy before resection. They view this procedure as a staging study. If the lymph nodes are negative in the OR, they lung lesion is excised. If they are positive, the patient will undergo chemo/XRT and then have the lesion restaged radiographically.

kidsallgone2002 said...

I am a cancer pt also a nurse. in Jan 08 I was diagnosed with right lower lobe carcinoma with probable metastic lesion in right hilar node. I had the bronchoscopy, the needle biopsy was told it was non small cell feb 18 had a right lower lobe resection and the tumor was removed along with 3 lymph nodes. the cancer was encapsulated and the 3 lymph nodes were negative. I was told by mt pulmonoligist, the thoracic surgeon and my oncologist that I was cured no further treatments were nedded that they had gotten all of it. My family and I were ecstatic. Went for my 4 month follow up CT the hilar node still showed up and on the PET scan it went from a hypermetabolic rating of 6.3 to a rating of 6.8. Now 4 months later I am facing chemo and radiation for 4 months. As a nurse I asked for chemo as a profolatic measure but was assured it wasn't necessary. Now 4 months later I have to prepatre myself and my children all over again. As a pt. I would of rather had been over treated than undertreated and have to start all over again

kidsallgone2002 said...

Please forgive my spelling area I am still a little angry and upset