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Glass Grain Opacity
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Glass Grain Opacity

CT for bronchitis 90 days ago. Showed nodule. Follow report :
" calcified granuloma is again seen in the right upper lobe. There is redemonstration of an ill-defined somewhat ground-glass opacity in the medial aspect of the right lower lobe which appears slightly more prominent, this is again an adjacent to moderate osteophyte.Miled dependent atelectasis and scarring are noted. There is a similar focal opacity in the lingula measuring 5.0 MM. No acute infiltrate is seen. There is no pleural effusion or pleural thickening.Calcified granulomatous complex is again noted in the upper right lobe.
Impression:
ill-defined somewhat groundglass opacity in the medial right lung base appears to have slightly increased from the previous study. there is a tiny new focus of similar appearance in the left upper lobe adjacent to the cardiac margin . While this appearance is non-specific, short term follow up vs PET CT is recommended to exclude slow growing malignancy".

Ok, my internist tried to reassure me she just does not think it is going to be serious ( as in cancer).
I have been , for the past year or so with a sometimes productive cough with mild bronchitis. Treated with anx and puffers. It should be noted border line CVID with 40 gms Gammunex infused monthly ( after years of chronic sinusitis recalcitrant to all treatment eventually).
Did smoke on and off over 17 years ago.
54 year old male. Robust health ( all things considered). Did have squamous cell skin cancer7 years ago. Removed.
Since I have been fighting the respiratory infection on and off , internist thinks could be infection ( blood was drawn).

Insurance company flat denied the attempt to precert the PET.
Next will be an appointment with a pulmonologist .

When I read online as a non-clinician, one time I think because it is "glass" looking, and grew(?) slightly in 90 days, it is 60-90% cancer. Other times I read , given the rest of the background and such, thinking it might just be pockets of infection or scarring.

I have felt shortnes of breath ( and continue puffers). Hoarse for couple years. But, assumed the usual sinus issues. The thinckness of mucus from the chest is relatively new thing ( last 2 years) and will go from think white to yellow. If I am sick, then green.

Feel free to comment on the odds of cancer, naturally I am following up with specialists and would not in any way hold anyone to online speculation.
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Avatar_m_tn
Hi,

The risk of malignancy is based on several features not just one. The size of the nodule is also important, as well as the shape and the regularity of borders. You mentioned one lesion as 5 mm, which by size criteria would be low risk. The pure ground glass pattern may harbor more cancer than the solid pattern, but the figures are more 50 to 70% rather than 60 to 90% (the data for this comes from a screening study in Japan, there is some evidence that Asian lung cancer may not be the same as for other races, hence, the applicability of these numbers may need to be qualified in the future).  I am not certain if the terms “somewhat ground glass opacity” is similar to a mixed solid/ground glass, which would have lower rates of malignancy – in the range of 30%. The current plan to continue surveillance is a reasonable plan. You could talk about the estimated doubling time if such data is available with the pulmonologist. The pure ground glass nodules tend to take a slower time, hence, some conventional definitions such as no significant change in size over 2 years may not be applicable (I hope I am not adding any more confusion). At the end of the day, the decision to continue surveillance or to intervene and go for the biopsy would be weighed on several factors, yours (personal cancer risk) and the nodule’s characteristics. Stay positive.  
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Avatar_m_tn
Thank you.  
Could be the doc wanted a PET to see if cancer was elsewhere , and had spread to the lung. The pre-cert people not budging does not suprise me . High cost imaging is the focus of the utilization review low hanging fruit these days. The nodule itself may be too small yet to rely on any results , so maybe just as well. I have read all sorts of false negatives and false postives on PET CT on this small a nodule. I see a pulmonologist Thursday, this will of course be a topic for discussion . Again, thank you .
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