PET scan - RML nodule

[Mayde]

My mom (62) had breast cancer about 12 years ago. She is been doing well, thanks to the Lord, but recently had an incidental finding while doing a pelvic CT Scan. They discovered a lung nodule in February this year. She had a CT Scan again in August and it showed that the nodule was stable (7mm in February and 9mm in August). The doctor ordered a PET scan in September and it showed SUV activity, same size. I am concerned, and think she should have a biopsy. Doctor will decide on the plan next week. Would love to hear your experiences and thoughts. Please see PET scan impression below.

 

Impression

1. 0.9 cm right middle lobe pulmonary nodule with abnormal FDG uptake suspicious for malignancy.
2. Moderately dilated esophagus with air-fluid level suspicious for achalasia.

Narrative

EXAMINATION: NM PET/CT SKULL BASE TO THIGH

EXAM DATE: 9/23/2024 2:53 PM

HISTORY: "RML nodule; hx of breast cancer"

TECHNIQUE: The patient was intravenously injected with 14.44 mCi 18F-FDG via a left antecubital vein at 3:20 p.m. PET/CT scanning began at 4:48 p.m. Prior to injection blood glucose was measured at 110 mg/dl and patient weight was reported as 68.04 kg. Images were acquired from the skull base to the mid thighs. The low-dose noncontrast CT data was used for attenuation correction and anatomic localization. Reconstructed images in the axial, sagittal and coronal views were interpreted. Quantitation was performed using maximum standardized uptake values (SUVmax).
 

COMPARISON: None prior PET/CT

CORRELATION: CT chest dated August 22, 2024

FINDINGS:

Limitations: None Image references: Unless specified otherwise the image numbers refer to the axial fused PET CT images uploaded in the PACS

Mediastinum and blood pool activity: Maximum SUV of 2.5 Liver background activity: Maximum SUV of 3.1

Head/Neck: Bilateral subcentimeter level 1, and level 2 lymph nodes with minimal low-level FDG uptake, probably reactive.
 

Chest: Heart and pericardium:No abnormal FDG uptake.

Mediastinum/Hilar: No abnormal FDG avid mediastinal lymphadenopathy. No abnormal FDG avid hilar lymphadenopathy. Axilla:No abnormal FDG avid axillary lymphadenopathy.

Lungs: 0.9 cm right middle lobe medial segment pulmonary nodule with abnormal FDG uptake, SUV 2.5.. Limited assessment of the lungs, due to low dose, thick slices, low lung volume technique obtained during shallow breathing.

Pleura: No focal abnormal FDG uptake. No evidence of pericardial/pleural effusion.
Chest wall: No focal abnormal FDG uptake.

Abdomen/Pelvis: Liver: No focal FDG uptake in the liver. Gallbladder: Cholecystectomy.

Spleen: No focal abnormal FDG uptake. Gastrointestinal tract: Oesophagus: Esophagus is moderately dilated with air-fluid level. Stomach: No focal abnormal FDG uptake. Bowel: No focal abnormal FDG uptake. Colonic diverticulosis. Peritoneum: No focal abnormal FDG uptake. Pancreas: No focal abnormal FDG uptake. Lymphadenopathy: No abnormal FDG avid lymphadenopathy in the abdomen or pelvis. Adrenal glands: No focal abnormal FDG uptake. Kidneys, ureters and bladder: Metabolic assessment of the genitourinary tract is intrinsically limited by urinary excretion of F-18 FDG. Allowing for this no focal abnormal FDG uptake. Pelvis:No focal abnormal FDG uptake. Genital tract: No abnormal FDG uptake. Calcified uterine fibroids. Abdominal Wall: No abnormal FDG uptake. Musculoskeletal: No focal abnormal FDG uptake. Multilevel degenerative changes are identified. Skin/Subcutaneous tissue: No focal abnormal FDG uptake.

Thank you.

[Tom Galli]

Mayde,

Welcome here. I'm not a physician so keep that in mind as you read my comments.

SUV (Standard Uptake Value) is a measurement of the amount of radioactive Iodine isotope absorbed by tissue. I wrote this piece on PET scans using information from one of my tests. It might help understand the PET process and SUV interpretations. SUVs from 2.0 and higher are suspicious for metastatic activity but values between 2.0 and 4.0 might be caused by other conditions, for example, inflammation or infection. Your mom's small nodule size of 0.9cm might be a hard target, depending on location, for a tissue biopsy.

That said, a tissue biopsy is the only way we can positively diagnose lung cancer. Here is more information about the ways biopsies for lung cancer are performed.

Stay the course.

Tom

[Livin Life]

Just seeing your post....   I'm hoping you have more information now though the doc appointment you referred to could even be today.  If they do a follow-up biopsy, etc. then it is obviously important this is your mom's primary health concern right now. 

Please just keep in mind, the esophageal issue for another time.  I'd recommend seeing a GI doc at a large medical center (they tend to - don't always) have more experience with these kinds of things.  If it is achalasia, that is rare and needs a specialist of specialists - a GI doc specializing in that.  Either way the moderately dilated esophagus screams autoimmune to me.  I have two autoimmune disease and my esophagus has been impacted in various ways, including the entire esophagus now being patulous (wide open).  that's considered "pseudo-achalasia."  I'd encourage you or your mom to ask for ANA blood work (PCP) though that can be negative and one could still have an autoimmune disease (e.g. 30-40% of Sjogren's patients, then often means neuro-Sjogren's-that's me).  Not saying she has an autoimmune disease though the esophageal issues make it highly suspicious....