Arm-Chair Rads and Oncs.

[cindi o'h]

Okay. Here is the report. Much of the initial Jargon I have omitted. To me, what she is saying is there might be disease present, then again, there might not be. I think that the SUV scale is 1 being the lowest and 15 being the highest, so much of the activity this time seems to fall right in the middle.

Anyone with any ideas?

INDICATION:

A PET/CT in August of 2005 showed non-specific uptake in the right adrenal gland with an SUV of 3.8.

FINDINGS:

There is a small focal lymph node in the right hilum with an SUV of 6.4. Low level radiotracer activity is seen on the lateral margin of the radiation scarring the the right lung parenchyma. This likely represents inflammation. There is also minimal pleural activity on the right, primarily posterior inferior, which may represent activity associated with the pleurodesis. There is an interesting linear area of activity involving the right anterior pleura which extends cranial to caudal. This appears calcified on the CT scan and is likely associated with the pleurodesis or previous chest tube track. The area of plura with mild increased metabloic activity on the PET scan also appears faintly calcified on the CT scan indicating the site of pleuradesis. The hightest SUV level in the right plerua is at the posterior right costophrenic angle where there is a bilobed area of increased metabolic activity with SUV level of up to 7.8. There is no radiotracer activity in the right adrenal gland. However without CT this pleural activity could easily have been mistaken for adrenal gland as it has a somewhat adrenal shape. This area is the only one suspicious for a small pleural-based metastasis.

IMPRESSION:

1. There is a small lymph node in the right hilum worrisome for metastatic disease.

2. Metabolic activity is seen associated with the right pleurodesis especially in areas of calcification on the CT scan and is likely inflammatory.

3. There is an area in the right posterior costophrenic angle of pleura which does have some calcification and therefore may be post inflammatory as well. However this is the area most questionable for metastasis in the pleura and the only area which may explain the right adrenal activity on the previous PET scan.

[Ann]

Cindi...don't have a clue about these reports but am certainly praying that the news is not bad!!!

[Patkid]

Cindi, I wish I was smart enough to have an opinion..........I bet Fay woulda known what it meant!

I can only pray and pray and pray.

I am doing that.

Love,

P

[gerbil runner]

Sounds like most of the activity is possibly related to your procedure, not disease. Which is good. If they're right.

If it were me, I'd want a different "read" on this scan, the CT mentioned, and your last prior scan. With 2 opinions, you'd feel better about "wait and watch" on the trouble area, or convinced that a biopsy is worthwhile. With only one wishy-washy opinion...well, this sort of thing can keep you awake at night.

[Shar]

Cindi,

Sorry but I don't have a clue as to what all of that means!!!!! I will however send you lots and lots of good thoughts and hope it is not bad news.

All the best girl,

Sharon

[Joe B]

Hi Cindi,

Sounds like the read is inconclusive. One comfort to take away is that the previously reported uptake in the adrenal looks like it was in error (thats good).

My untrained take is that they cannot separate between what is treatment related and what may be disease. I had a discussion with an oncologist recently about all the advanced diagnostics they have today and how just 5 years agao they would never have had this kind of information to assist them in setting a course of treatment. Its a two edge sword though because now they are seeing very minor things that could represent nothing, but how do you give a patient definitive recommendations when they have difficulty determining themselves what things represent.

What are your options? Can you ask for a re-read or a set of recomendations from the oncologist?

[bunny]

ok, so there's something to watch but also some very reasonable, non-cancer explanations...

wish I could say more. I hate this.

xoxo

amie

[eppie]

I want to say what Joe B said. Looks like what they see they aren't sure if it is treatment related or scar tissue.

Sometimes wait and see is wait and see.

Which bites the big one....I say have some fun....

Have another ct in a month or two.

Much love,

Eppie

[Bill]

Cindi > 2. Metabolic activity is seen associated with the right pleurodesis especially in areas of calcification on the CT scan and is likely inflammatory.

3. There is an area in the right posterior costophrenic angle of pleura which does have some calcification and therefore may be post inflammatory as well. However this is the area most questionable for metastasis in the pleura and the only area which may explain the right adrenal activity on the previous PET scan.

I noticed atop my wife's file ( last Thursday in ultra-sound in prep'n for her throracentesis ) a note stating that my wife's med onc requested " drain only ... no pleurodesis ". I asked the interventional radiologist about this and the reasons given for no pleurodesis were very similar to the comments mentioned in the excerpted PET / CT report posted above by Cindi. BTW, my wife's malignant pleural effusions have both been loculated with thick fluid ( clusters & sheets of malignant cells ). It took some doing ( lots of needle / catheter rotational and angular movements by the interventional rad ) and some additional equipment ( including a bigger bore needle / catheter ) but both times he was able to successfully drain the fluid. BTW, he told me that they purposely leave a small amount of fluid in the base of the pleural cavity as it's " dangerous to remove it ". Interesting comment. I know that this is also commonly done when ascites is drained off. As I vaguely recall this residual fluid helps inhibit or slows immediate reformation. Something to that effect.

B

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