Hoping someone can help me to understand my mother’s diagnosis

[JDella24]

Hello, and thank you for letting me post my question. 

In December 2021 my mother dealt with a minor stroke. Since then, things have gone downhill. During her numerous scans, they found nodules in her lungs. One became many and one larger than the next. Being my mother is now 71 and was a smoker until her stroke, the possibility of this being cancer was obviously very high. Thankfully after biopsy and surgery of right lung which was a wedge removed, and then markers placed in her left nodule, we were told what was removed was only fibrosis and she had no known malignancy. 
The newest PET scan I received results on has me very confused and concerned as it states:

History: Small Cell Lung Cancer; Restaging 

I’m hoping someone can help me interpret these findings as what I’m reading, in my head, this could be cancer and possibly slow spreading..?? I will be seeing her doctor for the results but I seem to get nowhere with them. Recently they asked if she’s had chemo or radiation, yet they never told her she needed it. I’m afraid I’m not getting her the care she needs, and would like to change that if need be. 
Her results below:

CHEST:

Postsurgical changes in the right upper lobe. No recurrent FDG avid right upper lobe nodule. Low level avidity of a 0.9 x 0.6 cm nodule in the left upper lobe, previously 1.0 x 0.6 cm which is less than blood pool (SUV max 1.0). Similarly, a 0.8 x 0.7 cm nodule in the left upper lobe also demonstrates low level avidity less than blood pool (SUV max 0.9). Fiducial markers are present adjacent to these masses. No new hypermetabolic nodule within PET resolution. 
(I’ve removed the part about her emphysema as I already understand that. 

Thank you. 

Edited April 22, 2023 by JDella24
Wanted to add the bit about the cut off on findings.

[BridgetO]

Hi JDella, and welcome. This is very odd! I understand why you're confused and concerned. If the biopsy showed no malignancy, there would be no reason for them to be restaging a small cell lung cancer. Was she referred for this PET scan by the same doctor who earlier said no malignancy?  It would be worthwhile to talk to that doctor about this, or if it was another doctor, to both of them. It's possible  that the radiologist misunderstood the reason for the referral. In any event, you and your mom need to get an explanation so you can decide how to proceed.  If you can't get a non-confusing explanation, I'd be inclined to find another doctor, preferably an oncologist specializing in lung cancer, or a pulmonologist with a lot of experience in LC to at least have them review records and give a second opinion. Let us know what your mom and you decide. I'm concerned and curious.

[JDella24]

Thank you so much for your reply. 
She has been seeing all the same doctors from the start. One is a pulmonologist; he is one who asked her if she’s had any treatment since the surgery, and he’s also called her by an incorrect name as of most recently. One more possibly minor, but a reason nonetheless, as to why I’d like to change doctors. She has also been seeing an oncologist, who is the doctor that ordered this PET scan, after having done a biopsy on at least one of the left lung nodules, which came back as non malignant. This just adds to my confusion since I always thought a PET came before a biopsy, but I could be mistaken. They did say they were unsure the biopsy sample they took was enough to give a diagnosis. 
Her oncologist is also one who asked if she’s had treatment after the surgery. Again, we were never told she needed treatment, nor that she had cancer, or anything more than fibrosis. If they had told us differently, I would have made sure she was getting the treatment she needs, as soon as she was cleared to. I think it’s time for a new set of doctors for my mom.
Thank you, again!!
 

[Tom Galli]

JDella,

Welcome here. First the disclaimer. I'm to a radiologist nor a physician but a 19-year survivor of lung cancer and have had many PET scans. Here is something that might help you understand the language of the PET report.

In a general sense, anywhere you read "no FDG avid" or "low-level avidity" or SUV max of 1.0 or 0.9 means no problem. The concerning language is: "History: Small Cell Lung Cancer; Restaging". It is possible that the radiologist mistakenly titled the report. But, the language used to describe your mom's condition is good news, and not concerning. Certainly, there are no words pointing to a spread or new metastasis and these words would point to restaging. I hope this helps till you get a further explanation.

Stay the course.

Tom