Second opinion diagnosing lung mass

[ctmsnr]

I have a 39 year old son.  He is a non-smoker.  Recently an x-ray turned up a lesion on his right lung.  A PT scan indicated a 3 x 5 cm nodule/mass in the peripheral tissue surrounding the lung. A portion which has pushed the lung inward slightly.  The radiologist reported this a likely benign nodule consisting of fat.  

A subsequent thin needle biopsy was negative/inconclusive (I was later told a core biopsy would have been required to rule out malignancy altogether).  A different radiologist performed this procedure and said he also was almost certain the nodule was benign.

An FDG-PET was next performed and a metabolic rating of 3.8 was discovered in the nodule.  This third radiologist deemed the metabolic activity high enough to be suspicious.  She  said it was borderline and this was disturbing. She said there was no evidence of metastasizing in her PET analysis.  

My son's pulmonary specialist, who also believes this not a malignancy,  has suggested waiting six weeks before doing another PT scan in hopes the nodule will have decreased in size.  Otherwise, surgery would likely be done   All these physicians have assured me there is no danger in waiting six weeks.  

I have two questions:  Do you agree there is no danger?  If I should want a second opinion at some point, can the secondary physician have access to all the radiology data for his/her own interpretation?  

I am hoping a different pulmonary specialist could do whatever is necessary to render a second opinion from the existing data.  It has taken a month to perform all these tests.

Thank you for any input,

Ctmsnr



      

[ctmsnr]

Thank you for your previous help.  

I have continued to study my son's lesion.  One important point.  The PET radiologist said this was a soft tissue lesion.  I saw the thing and it appears to be in the lining around the lung, pushing against the lung.  The pet radiologist said as much.  

Based on everything I'm reading this is a soft tissue lesion and, worst case some form of liposarcoma (all three radiologist involved say it consist of fat cells).  These things occur in only 1+ percent of all cancers.  So nonspecialist seldom see them.

What continues to worry me is my son's lesion had an SUV of 3.8.  This was the statistical mean for existing sarcomas in a study of PET reliability performed at the University of Washington.  

The coordinating physician is a pulmonary specialist.  My question is should a specialist in soft tissue tumors be the doctor I would request for a second opinion, or even to be part of his diagnostic team?

Thank you again, Dr Roque

[Fernando Roque, MD]

Hi.  The tissue sample taken by fine needle aspiration biopsy is typically smeared onto a glass slide and examined under a microscope to look for cancer cells.  If the smear is bloody, it becomes difficult to look for individual cancer cells  as there is a lot of blood "cluttering" the view.  That's why a core biopsy is superior because more tissue is harvested, and it becomes easier to delineate the tissue itself from the surrounding blood and debris.

[ctmsnr]

Thank you for your prompt reply, doctor.  I was being reassured by all involved up to the point of the PET.  A great deal of that was based on the appearance of this nodule (not characteristic of cancer), my son's age, and the fact he is a non-smoker.  

The PET was done after the biopsy.  I think they got the sequence backward and, nobody's told me, but I believe a core biopsy would have been been done had they seen the metabolic activity first.

This is a soft tissue nodule with rounded edges.  No calcification.  The biospy radiologist told me they mostly got blood.  Are cancer cells never, or sometimes, not in blood samples taken from a nodule?

My son has an autistic spectrum disorder and is disabled, so I am very involved.

Thank you again,

Ctmsnr

[Fernando Roque, MD]

Hi.  If your son does not have any symptoms right now other than the lung nodule, then waiting for another six weeks is probably reasonable.  Another option is to go ahead and perform a core needle biopsy instead of waiting it out for six weeks.  I don't think a repeat PET scan is the most cost-effective way of differentiating if the nodule is malignant or not. A CT scan would probably suffice, in addition to the core biopsy.  

If you feel you need to seek a second opinion, then by all means, do so.  The second physician shouldn't have any problems accessing the previous laboratory and radiologic material.  But you probably need a formal written request from the second doctor to be able to obtain your clinical records.