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Chest wall needle biopsy and lung needle biopsy 2-16-05


Don M

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Last Wednesday I had 2 needle biopsies done to follow up on a 2-7-05 PET scan.

The PET scan had shown uptake and a fill-in oncologist advised me to forget surgery and go on chemo since I had uptake at the chest wall, at a new nodule and near the right hilum. I went to see the surgeon the following Friday who said that uptake on a PET scan does not prove cancer. The surgeon referred me to an interventional radiologist to do the needle biopsy. I also talked to the pulmonologist that day, and his opinion on the upake at the right hilar area is that it is negligible and not worth considering. If there was cancer there it would be from a lymph node, and none showed up in the CT scan.

After I arrived at the hospital for the biopsy, I spoke to the radiologist and he said that he would like to also do a biopsy of the nodule if the preliminary pathology showed no malignancy in my chest wall. I told him I liked that idea just fine.

The chest wall showed no malignancy on preliminary testing, so they also did a needle biopsy of the nodule.

I got a copy of the report on Friday.

Below is an excerpt from the pathology report:

SPECIMEN SOURCE (from requisition):

A. LLL (LEFT LOWER LOBE) LUNG BIOPSY

B. LEFT CHEST WALL MASS

INTRAPROCEDURAL EVALUATION:

A. Nondiagnostic JMO

B. Nondiagnostic sample ROW

GROSS DESCRIPTION.

Two sets of slides and two PreservCyt vials containing fluid specimens are received. Each slide and fluid container is labeled with the patient's name, "Miniken, Donald."

Part A. Five fixed and five air-dried slides are received, In addition, a PreservCyt vial containing 20 ml of slightly cloudy fluid is received, from which one thin layer prep and one cell block are made.

Part B. Five fixed and five air-dried slides are received. In addition, a PreservCyt, vial labeled with "L chest wall” is received. The vial contains two tan-red biopsy cores in cloudy tan fluid, from which one thin layer prep and one cell block are made.

MICROSCOPIC DESCRIPTION:

A, B. Twenty-two smears and two cell blocks are reviewed. The smears demonstrate blood and infrequent benign cells. No malignant cells are seen. One of the cell blocks has blood and skeletal muscle without evidence for malignancy.

FINAL Diagnosis:

A, .B. "Left lower lobe of lung": nondiagnostic.

So, all I know for sure is that I have a nodule and some kind of mass at my chest wall.

The PET scan is marginal for indicating malignancy. The biopsy found no malignancy. I know that does not necessarily mean there is nothing there. Needle biopsies are not reliable for negative results. But, I think that they got some good tissue samples in pathology.

I like the part in the pathology report where they use words like "benign cells" and "no malignant cells are seen". I have a history of a benign tumor at the very same site in that lobe. You might think a benign history would be an important factor to consider, but the fill-in oncologist was thinking lung cancer history I guess.

Well, anyway, I think the PET scan is more wishy-washy, in terms of interpretation, than the needle biopsy, in this case. I remember that I asked the fill-in onc what he thought about the probability that I had cancer again, and he said it was 90% certain. Right now, my un-expert opinion is that there is a 90% chance I don’t have a recurrence.

So, what do I do now? Well, tomorrow, I have an appointment to discuss the biopsy results and whatever else with my surgeon. He will probably present me with options. I am going to go ahead and guess.

1.Wait and see. No surgery now. Continue to monitor with ct and pet scans.

2.Open me up and do a full biopsy of the suspect sites.

a. If a malignancy is found at the chest wall area end the

operation and go on chemo.

b. If no malignancy is found at the chest wall, test lymph nodes

at my mediastinal and right hilar areas. If these areas show

malignancy, end the operation and go on chemo.

c. If no malignancy is found at sites outside my lung, remove

the nodule and test it for malignancy.

1. If the nodule is malignant, remove the rest of my lung.

Do follow-up chemo.

2. If the nodule is not malignant, end the operation and don’t do

chemo.

I wonder what the surgeon will say.

Don M

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Hi Don,

Keeping my fingers crossed that you will get good news from the surgeon.

Please keep us infomed. This has to be such a stressful time as you will probably find out tomrrow what is to be done.

Thinking of you and sending out healing meditation.

Maryanne

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Thanks for your support and responses everyone.

I saw my surgeon today and it took me about 2 minutes to decide to have an operation. The data that we have now does not prove or disprove cancer. The next step would be to open me up and do a complete biopsy. There is an unknown mass at the chest wall. It showed uptake. It is not shaped like a tumor. It may be just inflamed scar tissue. The first thing they will do is to check out my chest wall. If there is a malignancy at my chest, the operation will end. I will be restaged (stage III I think) because the cancer will have left my lungs. It will be inoperable once it gets in the chest wall.

So, if the chest wall and other sites (outside the lung) prove no cancer at the time of the operation, the surgeon will do a wedge resection of the tumor. If the tumor is malignant, I will have the rest of my lung removed and I will ask for adjuvant chemo.

I think it is probably all benign, but I am not going to bet my life on it. I want the operation to put the matter to rest.

If the insurence clears it, in time, I will hae the operation this Friday. Otherwise, I will have to wait a week longer. I hope it is this Friday.

It will be a full thoractomy because I probably have too much scar tissue to use the scope effectively. the surgeon says it is like looking through a kelp forest if there is a lot of scar tissue.

At least I know pretty much what to suspect this time.

Don M

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Don,

Thank you for the update. I think you are totally doing the right thing. My feeling is if there is something in there that doesn't belong there, I want it gone and gone now! I hope this Friday works for you, if not at least a week isn't too long to wait and you do know what to expect in terms of recovery.

I am praying for the best possible outcome.

Cindy

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Barb: I have no medical backround at all. I just learned what I needed to know about my disease. It helps me cope with it. It gives me the sense that I am doing something about it. The people on this site and the ACOR mailing list have helped me a lot. And I just did a lot of on line research. Yay for the internet.

Thanks again y'all.

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My surgery will be this Friday. Here I go jumping off the deep end again. Tomorrow I am going to stay home from work and get a bunch of firewood all split up. Thursday is preop stuff in the afternoon at the hospital.

Thanks again for your prayers and support everyone

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