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4/4 Chest CT Scan Results


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For comparison, here's what the 3/28/05 PET reported ( lung portion only ) :

FINDINGS : There is a focus of moderately intense hypermetabolic activity in the left upper lobe of the lung. This measures approximately 1.4 cm. and demonstrates standard uptake value of 2.4, borderline for malignancy. This could represent partial response to therapy. ( Note : primary tumor was measured at 2.6 cm. per 1/20/05 CT scan ).

There is no evidence of other hypermetabolic foci in the lungs, but they may be too small to visualize.

IMPRESSION : Solitary focus in the left upper lobe, probably partially treated malignancy.

Here's what the 4/4/05 Chest CT reported :

FINDINGS : Spiculated mass, left upper lobe, seen measuring 22 mm., axial image # 15. Very small nodules are seen in the lungs diffusely. These have undergone significant interval diminution in size compared with the CT exam from 1/20/05. No evidence of mediastinal or hilar adenopathy. Thoracic fixation rods and interposition graft are again seen.

IMPRESSION : Spiculated mass, left upper lobe, measuring 22 mm. Small nodules seen diffusely throughout the lungs in the 1 - 2 mm. range. Significant interval diminution in size compared with the 1/20/05 exam. No clear-cut mediastinal or hilar adenopathy. No evidence for axillary or supraclavicular adenopathy. No evidence of pericardial effusion.

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This sounds good to me. What do you think? Did you meet with her oncologist and get his spin on it?

Give your wife an extra hug from me tonight.



Peggy et al :

Here's the problem with my wife's PET / CT results. An interventional radiologist commented that the real ??? is - are those numerous " very small " lung nodules that are under the PET radar inactive ( dead ) residue OR viable tumors simmering and waiting to take off ? Obviously, what is needed is a radiology machine or technique that can both spot very small nodules like the CT can AND identify them as active or not like the PET can. Separately, an x-ray tech that I know scoffed at the notion that 1 -2 mm. lung nodules can be accurately identified on a chest CT ( as has been done in my wife's chest CT report ). She said that in her opinion identifying lung nodules in the 1 -2 mm. range on CT is largely guesswork and the accuracy is very poor. What do you think about that ? Obviously, my wife has improved vs. Jan. ' 05. For that I'm grateful. But, given this significant uncertainty about those numerous very small nodules in BOTH lungs, I can't help but be somewhat disappointed in the results.

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Dear Bill,

I see your dilemma. I think it's always frustrating to not know. Sometimes knowing is hard, but at least for me, not knowing is harder. The bad news is that it doesn't sound like you have much choice but to wait it out. At least she's getting good treatment (Tarceva) thanks to your loving efforts and diligence, and thankfully, the Tarceva seems to be working.

I know this isn't an information-type post, and I know that's what you're seeking, but I just don't have any answers. I do want you to know, though, that I think I feel your frustration. That's kind of how I felt when they told us that two of my husband's brain tumors had grown "a little", and all we could really do at this point was watch them and see what they do, treat any symptoms, and re-scan in 4 months. Not a very satisfying answer, but I do very much understand the limitations of our oncologists and radiologists and entire medical team. They can only do and offer so much.

I wish there was some way to get around this tortuous waiting game, but I don't think there is. I wish I could offer you more because I know how hard you have worked, probably day and night, seeking answers for your wife. I powerfully believe that there is always hope. Six months ago (I think), we didn't even have Tarceva. One or two months from now, there will hopefully be something else. Hope is on the horizon.



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Bill: I am not an expert, but I would question a radiologist report that identifys structures in the 1 -2 mm range as nodules. I would think the report might say that they could be nodules, scarring, or pleural based densities that could be nodules.

As Peggy says, the tarceva seems to be working. For me the next step would be to do a follow-up ct scan in 3 months to see if the 1-2 mm stuff has changed.

You and your wife have my best wishes.

Don M

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