Response to NJC-R.N.-DC, about the 9.00mm nodule in the RLL from advice.

[advice]

First, Thank you so much for your response I appreciate the information and wanted to respond to your answers. The information that I was told by the Pulmonologist and Oncologist
is opposite of what I thought I knew to be true, being an R.N. myself too.  They led me to believe they think this is an active cell because of the 5.0mm growth in 10 months and have already discussed options of radiation and chemo.  My feeling is I would hate to have her go through the needle biopsy if unnecessary because she does not tolerate procedures well. Oncologist opinion was we could wait 3 months because of it being slow growing and scan again, Pulmonologist opinion why wait it has already shown growth, needle it now, because she is feeling it is malignant based on the fact it grew. My feeling is that this could be another granuloma showing up like on the previous CT I spoke about and that they do in fact grow as you have stated as well. As well as the fact that on previous CT there are findings of healed gramuloma disease and she did as I spoke about have an infection in the last 6 to 8 months. Pulmonologist is the primary on this because of the location and obvisiously not the Oncologist because we have no findings yet. I am looking for other options that you could suggest so that I can help her make a more informed decision. I still want to speak to a Radiologist about PET findings because of the information I am finding about 1cm and up lighting up.  Which is why we have this dilemna because it is just under and Pul. feels this is why it is not lighting up. Any information appreciate

[National Jewish]

As you know the PET scan is not as sensitive for nodules <15 mm or <1.5 cm.  So please talk to the radiologist about the PET scan findings.  The nodule in question lies adjacent to a calcified lesion, so it not truly a solitary nodule.  Since it is in near a benign lesion, it is more likely to be benign.

Just as a negative PET scan is not entirely reliable with such a small lesion, a negative needle biopsy is equally non-predictive.  If there are other reasons to suspect that this lesion is malignant, I would consider excising it, rather than blindly starting chemotherapy and radiation therapy.  The bottom line, as you know, is that the doctors who are there and have all the facts must make this decision.

[advice]

Thank you Ellis7 for the information and web site.  I have to go on the site to check and see of the FDG-PET is a more specific PET as far as I know hers was a PET scan, they may be one in the same I will check on the site you recommmended. I suggested a Bronchoscopic and Fluoroscopic biopsy but the Pulmonologist said that because of the location and the size this would be better obtained through a needle biopsy.  My opinion was to wait as well in hope this would turn out to be another healed calcified granuloma as noted on her previous CT's as noted in the 10-29-03 question. The Oncologist and Pulmonologist are suspecting this to be magilnant and will still need to be biopsied and to do sooner would be better.  They're opinions are based on the fact this is growing therefore this is why I am asking the questions and finding my belief to be true that granulomas do grow, benign growths do grow. Both M.D.'s feelings are they do not normally grow in either of the above and the reason for their recommended TX. Thank you again!(also the measurement is 9.0mm the question is a typing error)

[Ellis7]

Here's a link:
http://www.rad.kumc.edu/nucmed/pet/pet_fact_sheet_799.pdf.
Excerpt:
"The nature of a solitary pulmonary nodule can be determined with high accuracy using FDG-PET imaging. For nodules greater than 1 centimeter in diameter the overall sensitivity and specificity are 83 and 90%, respectively. In contrast, the nature of such solitary nodules cannot be determined with anatomical imaging modalities such as CT or MRI. "

I think the pulmonologist would recommend a brochoscopy biopsy, then a lung needle biopsy.

I think waiting 3 mo and repeating the CT makes a lot of sense,
since this is a noninvasive test and the nodule is small.