Cat Scanversus Pet Scan for lung nodules

mrsb45

I thought I would ask you ladies because I respect your unbiased knowledge on soo many topics. I read the boards frequently and occasionally post but have done less as i am trying to not think about BC every day (although I still do), I had a local recurrance at the same site 10 mos. after having 3 lumpectomies and 7 weeks of rads. Next had BMX (left prophylavtic) with 4 DD of AC and 12 weekly Taxol. I find my chest scans to be nerve wracking because I've had 4 since origianl Dx. for lung nodules (2mm in size).. Originally had one, follow up scan showed no change but now had 2. Next showed no change in either scan. This March showed another new nodule(total-3) but no change in other 2. I go to a respected Cancer center in Mass. but my oncologist doesn't seem at all concerned and more aggravated with radiologist for mentioning these 2mm nodules .Would a Pet scan be more specific. She is against me having a pet scan and says the chest scan scan is better to pick up if there was any mets to the lungs. Would appreciate your experience and recommendations. Thanks soo much ....

BeingHopeful1

Hi mrsb!

A lung nodule was recently discovered on my Mom's X-ray after she went to her doc for what evidently was pneumonia.  This was about 2 wks after her BC diagnosis.  She met with her BS for the first time tonight, and she ordered a CT scan to get a look at the nodule as opposed to PET.  She didn't really say why or go into the differences b/w the two tests.  I know you were looking for an educated answer but I just thought I'd let you know our BS chose CT as well!  

Her BS didn't seem that concerned of mets either but I suppose it would be negligent if they at least didn't look into it!  

Take care! 

REKoz

My pre chemo PET found a lung nodule as well. It hasn't changed in the almost 3 years (coming Nov) since. My Onc. watches it with a PET scan every 6 months so far. Hoping he will reduce that to anually pretty soon. I think he is overly cautious because I was a long time smoker.

The further away I get from the trauma of bc, the more I hate going for these tests. I did a little reading on the difference between a CT and PET before my test last month because a CT is so much easier- in both time and prep restrictions. From what I gathered, the PET is the standard in finding cancerous tumors. More detailed organ images of the entire body. Usually a CT concentrates on certain areas. I could be wrong since my brain turns off rather quickly when anything medical or scientific attempts to compute! 

Reading your story now has me wondering. Surely I don't question your MD's opinion. That said, I am curious if there is a difference in testing for mets vs. testing for an entirely different type of cancer? Hummm..

Anyway, you can google these scans and maybe understand their difference better than I. I do know that lung nodules found on any test is not uncommon and most often caused by scar tissue. I've read of many benign nodules found on our sisters here.

Wishing you the best. Ellen

mrsb45

Thanks you both for your responses.. I agree that the further I get away from BC I almost don't want to deal with the tests anymore..I've also put off doing part 2 of the reconstruction process because after 2 years of BC I didn't wany anymore surgery. I have recently considered having it done as I feel it might make me feel better about how I feel.. Regarding the cat scans I just wish for once it would say "no Changes" but everytime there's a new nodule.. My onc says they are so small that they shouldn't even be mentioning them but for legal puposes they document everything. Wishing you both the best also and thanks again for your help.. Joan

Basia

Thanks for posting this! I am going for a follow up CT scan for lung nodules found on my PET scan last year.  They had me go back for CT scan and x-rays after the PET but told me it was nothing to worry about.  I was too freaked out about BC to ask too many questions, I was just happy to hear it wasn't cancer. Now that I am getting ready to go for the follow up I am starting to freak out again. Is it normal to go back to check on these lung nodules even though no body was concerned with them originally? I keep thinking the onc heard something in my lungs that he didn't like and thats why I need to go?

LRM216

Yes, it's necessary to check.  If they have not changed at all - that's a good sign and what they will be looking for.  Please don't forget that many nodules on lungs are scars from things we have had happen to us earlier in life and can completely be unaware of.  Unfortunately, that's one of the downsides to CTs and PETs - as they pick up absolutely everything - benign as well as more dangerous things.  I have had a small lung nodule for years - found innocently on a chest xray 12years prior to my ever even thinking about breast cancer - and it's not changed in over 12 years.  Hang tight - the scanziety is the worst part for any of us and it's not easy to get through, as we all know.  Wishing you all the best,

Linda  

bevin

Hello, I also have a lng lesion 3cm x 6cm.  I had a CT scan and then a combo Pet/Ct.  I read an article that stated a combo Pet/CT is the best way to scan lung issues. Sorry, I cant figure out how to do a link, but here is a really good article.

PET for the Evaluation of Pleural Thickening

Observed on CT

Henk Kramer, MD1; Remge M. Pieterman, MD, PhD1,2; Dirk-Jan Slebos, MD, PhD1; Wim Timens, MD, PhD3;

Willem Vaalburg, PhD2; Gerard H. Koe¨ter, MD, PhD1; and Harry J.M. Groen, MD, PhD1

1Department of Pulmonary Diseases, Groningen University Hospital, Groningen, The Netherlands; 2Positron Emission TomographyCenter, Groningen University Hospital, Groningen, The Netherlands; and 3Department of Pathology and Laboratory Medicine,Groningen University Hospital, Groningen, The Netherlands

Early discrimination between benign and malignant pleural diseases

is vital for the treatment and prognosis of a patient.

Imaging is traditionally performed with CT or MRI, with an

accuracy of 50%-75%. PET has proven to be superior as a

diagnostic tool in several malignancies. In this prospective

study, PET results in patients with pleural abnormalities on CT

were compared with histologic results. Methods: Eligible patients

had pleural thickening on CT and were medically fit for

surgical diagnostic procedures. All patients underwent PET.

Qualitative assessment led to a PET score of 1 (definitely normal),

2 (probably normal), 3 (probably abnormal), or 4 (definitely

abnormal). PET scores of 1 or 2 indicated a negative PET

finding, whereas PET scores of 3 or 4 indicated a positive PET

finding. Pathologic verification techniques included thoracocentesis,

thoracoscopy, or open pleural biopsy at thoracotomy.

Results: Thirty-two patients were enrolled, 19 with malignant

and 13 with benign pleural disease. PET was true positive in 18

and true negative in 12 patients, with an accuracy and negative

predictive value of 94% and 92%, respectively. PET was false

negative in a patient with a slowly growing malignant solitary

fibrous tumor and false positive in a patient with infectious

pleuritis. Median standardized uptake values calculated for 7

patients with malignant and benign pleural diseases were 6.28

and 1.69, respectively. Patients with a PET score of 1 or 2

survived significantly longer than patients with a PET score of 3

or 4. Conclusion: Qualitative assessment of pleural thickening

with PET accurately discriminates between malignant and benign

pleural thickening, with a high accuracy and negative predictive

value.

Key Words: PET; 18F-FDG; pleural diseases; mesotheliomaJ Nucl Med 2004; 45:995-998Determining the etiology of pleural thickening remains a

challenging clinical problem. Early discrimination between

benign and malignant pleural diseases is vital for treatment

and prognosis. In particular, malignant pleural mesothelioma

(MPM) has to be distinguished from other causes of

pleural thickening. MPM has an unfavorable median survival

of 4-12 mo, because of a usually long interval between

presentation and diagnosis and the local aggressiveness

of the tumor (1). However, a few selected patients may

benefit from chemotherapy or trimodality treatment (2).

Traditionally, pleural diseases can be imaged by chest

radiography, CT, and MRI. CT is more accurate than chest

radiography (3) and has been used for the assessment of

MPM for more than 15 y. In several studies, CT and MRI

performed equally well in the staging of MPM, with an

overall staging accuracy of 50%-75% (3-5).

Whole-body PET with 18F-FDG is a noninvasive metabolic

imaging technique and an accurate diagnostic and

staging tool for several types of malignant disease (6). In

particular, PET has proven accuracy in the diagnosis of

solitary pulmonary nodules and the preoperative staging of

non-small cell lung cancer (7,8). A few reports are available

on PET in the evaluation of malignant pleural diseases

(9-13). These reports show an overall accuracy of 88%-

92% for PET. Only 2 limited studies could be found that

evaluated PET in the differential diagnosis of pleural diseases

(9,14). Therefore, we prospectively evaluated the feasibility

of PET in the diagnosis of pleural thickening on CT,

with pathologic results as the gold standard.

MATERIALS AND METHODSPatients

Consecutive patients who had pleural abnormalities and presented

at the pulmonary outpatient department of the Groningen

University Hospital were evaluated by history, physical examination,

complete blood cell count, renal and liver function

tests, chest radiography, chest CT, and bronchoscopy. Eligibility

criteria for this study were pleural thickening on chest CT,

medical fitness for surgical diagnostic procedures (thoracoscopy,

open pleural biopsy, thoracotomy), and an age of at least

18 y. Patients were excluded if they had hyperglycemia (serum

glucose 10 mmol/L) (15).

Thirty-two patients were included. All patients gave informed

consent before enrollment. The study was approved by the Medical

MrsChorlton

I have 3 nodules, one 2mm, one 3mm and one 7x8mm. all in different sections of lungs. I go back in for another CT scan day after tomorrow to check on them. I asked my onc about getting the CT/PET combo scan and he said my insurance will not cover it unless they see a change in the size of the nodules. If there is any change I will go see a pulmonologist. I was kinda pee o'd about that. I mean I saved them over $45,000 by not getting any rads! (LOL) I just want to know if the nodules are benign or malignant so I can be proactive and get rid of them. ;-)

I was a heavy smoker for 23 years but I quit 12 years ago, and havent been near smoke or smokers since. 

Basia

Went for my follow up ct scan on Saturday, the oncologist's PA called me today and said everything looked good, another follow up in 6 months. I was so releaved! I was terrified because I have had this miserable cough for a while now and of course my mind went to the dark place thinking everything is cancer. So now I am doing a happy dance:)

Thank you all!

MrsChorlton

That's great news Twinmom! How long have you had the cough?

mrsb45

Great news twinmom.!!! These scans and this disease really do test our nerves. I guess it depends alot on our onc. and what there looking for whether they order a cat scan or a pet scan...I know other people with differents kinds of cancer who always have pet scans so I was curious if one is more precise than the other??

MrsChorlton

I also have some outstanding news!

I went in for my Lungs CT yesterday and The largest 8mm nodule has SHRUNK to 4.5 mm and the 3mm one is completely GONE, and the 2mm one turns out to be a vessel!!!

It had only been 2 months since my last scan, and wow how wonderful is this?!

I believe the alternative supplements are working!! I'm over the moon right now!!

Basia

MrsC, that is wonderful news! What supplements are you taking?

I think the CT is more accurate.  I think and this is just my opinion, that the PET scan notices metabolic activity and shows the radiologist or onc what areas need further exploration and then they order a CT or Xray of the precise area.  Again, just my opinion, not fact.  

I've had this cough since January on and off. I think its from the herceptin I am still getting every 3 weeks.  It causes a runny nose, but in my case, its creating a post nasal drip which is making me cough.