VAT assisted lung biopsy

Primavera

Hi all. Hope you are all doing well in these crazy times.

I was diagnosed with endometrial cancer last year; grade was 3 so I had a hysterectomy really fast on April 15.

I was staged 1A. The pre-operative scans revealed 2 lung nodules (stable at 3mm each up till now), but also a section that is 0.9cm of ground-glass opacity. I also have a tiny 3mm "lession" in liver that has not grown and doesn't show up on ultrasounds.

CT scans have been done since March 2019: 3/19, 9/19, 12/19 and 7/20. The radiologists reports have been saying the same thing all along: lung nodules stable, ground-glass opacity stable, probably benign.

My pulmonologist almost drove me crazy 12/19 because she "saw more than the radiologist saw." Sent me for those 12/19 CT scans and for tuberculosis tests (negative) and called me next day 12/24/19 to tell me everything was OK.

Forward to 7/20, two weeks ago, when I went for the CT scan. She called me into her office again and said she doesn't trust the radiologist report (again) and that she wants to do a VAT-assisted surgical biopsy. She talked to my oncologist and it looks like she convinced her I should have this.

It's still surgery, though minimally invasive, but I've read a lot about how this procedure gets overused. I read everywhere that a PET scan should be the next step, but don't know why that's not suggested.

Has anyone had this kind of biopsy? They're saying it's only a one night stay and that it's a same-day procdure and they're pushing for it to be done as soon as I can. I got my two last CT scans on a CD, but pushy doctor and nurses are saying things like "it's no use to send to another radiologist, because they might say the same thing as this one, and they don't make the diagnostic decision."

LisaPizza

How frustrating.  I wonder if

How frustrating.  I wonder if they think the size is too small for PET?

Forherself

Second opinion?

Am I reading correctly that they have not grown in a year?   If that is the case I would ask for a second opinion, preferably from someone not in the same group.   There are risks from the procedure, and some groups are more aggressive about it.  You could even be exposed to infection in the hospital.   Ask your family doctor for a referral for a second opinion, in my opinion.

And I mean the second opinion from a pulmonologist. 

Primavera

Forherself said:

Second opinion?

Am I reading correctly that they have not grown in a year?   If that is the case I would ask for a second opinion, preferably from someone not in the same group.   There are risks from the procedure, and some groups are more aggressive about it.  You could even be exposed to infection in the hospital.   Ask your family doctor for a referral for a second opinion, in my opinion.

And I mean the second opinion from a pulmonologist. 

Yes.

Nothing has grown for a year according to the radiologists that the pulmonologist doesn't want to believe. 

I called the pulmonologist's office to ask a few questions about hospital stay and timing (they said it's one day only without complications). Her nurse was already taking out the calendar to put me in for surgerical biopsy on August 6. When I said "not so fast" she said "what about August 11. "Then she said that since I had the CT scan done on 7/7, I can't go past 6-8 weeks from that date because I would require a new pre-operative CT scan and perhaps insurance wouldn't cover that.

Nurse said pulmonologist is not too worried about the solid 3mm nodules, but about the ground-glass opacity of 0.9cm. She said that previously it was measured at 0.84cm and it grew to 0.96, but they always round it down, not up. That is true according to what I've read, but it's also true that maybe she could wait a few months to do this biopsy. I've read about the risks, too: collapsed lungs, infection. 

Primavera

LisaPizza said:

How frustrating.  I wonder if

How frustrating.  I wonder if they think the size is too small for PET?

Size

That might be a reason. The size. The pulmonary nodules are actually just 3mm and there's only two of those and pulmologist is not worried about those. It's the 0.9cm area of ground-glass opacity that she says could be a metastasis...or maybe not, but I should want to know.

NoTimeForCancer

well first, good for you

well first, good for you saying, NOT SO FAST.  I agree with Forherself that asking someone outside that group for a second opinion.  Your pulmonologist sounds like she is very persuasive, and she might be right about it in the end, but it sounds like there is work to do. 

Primavera

NoTimeForCancer said:

well first, good for you

well first, good for you saying, NOT SO FAST.  I agree with Forherself that asking someone outside that group for a second opinion.  Your pulmonologist sounds like she is very persuasive, and she might be right about it in the end, but it sounds like there is work to do. 

Thank you for your answer

Yes, all I want is for this not to be such an emergency when it hasn't been before and it hasn't grown for so long.

These ground-glass opacities are slow-growing and that's why they watch them for 3 years. It's only been a year and all I'm asking is for six more months to see what happens in the next scan; or even three more months, not 3 weeks.

MoeKay

Second Pulmonologist Opinion

I didn't have a VAT-assisted surgical biopsy, but had a transbronchial lung biopsy during which my lung was punctured.  It was supposed to be an outpatient procedure, but ended up being a three-day inpatient hospital stay, during which I needed to have a chest tube inserted to keep my lung from collapsing.  As a result, I would urge you to get a second opinion from another experienced pulmonologist regarding your need for the biopsy. 

My story is very long and I don't want to bore you with too many of the details.  My situation was different, though, because I had a severe cough that sent me to the ER where the months-long ordeal began.  My chest CTs found, among other things, ground glass opacity.  One of the radiologists stated that the differential diagnoses included but were not limited to multifocal pneumonia, tuberculosis, sarcoidosis, eosinophilic granuloma and pneumoconioses.  However, given my endometrial cancer history, there was also concern that I might have metastatic cancer.  In the end, I didn't have any of the aforementioned, but was diagnosed with eosinophilic pneumonia. 

I realize that you had a grade 3 cancer, so you don't want to delay getting to the bottom of things, but your case sounds sufficiently complex that a second pulmonologist's opinion seems appropriate and warranted.  There is risk to any invasive procedure, so I would want to discuss with several pulmonologists whether there are other non-surgical options at this point. 

Good luck!

BluebirdOne

Call your insurance to confirm

what they will cover and when. Get it in writing. You can always schedule then cancel if you get enough info. In this time of Covid I would certainly be very sure you need this procedure, or if you need it at all. 2nd opinions are gold. Good luck to you! 

 

Denise 

Primavera

Thank you all

I'll start getting on this tomorrow. Thank you for all your help.

oldbeauty

Fight the Fear!

Primavera, I'm so sorry to see this development.  I hope you can get in to see a good specialist asap to put your mind at rest and develop a treatment plan you can support.  Doublewhammy posted a few days ago on the Kaleena thread; maybe you can privatemessage her.  Donna Faye, I believe, also had breast cancer many years ago before the UC she's in treatment for now.  I only had a scare 3 years ago while in the midst of chemo.  Like you, I went for a routine mammo and then got called back for an ultrasound and a 3D image.  They told me I needed a biopsy; that I likely had an early stage ductal carcinoma in situ.  I was freaking out...and then it turned out to be benign calcifications.  So, I lucked out and you, alas, did not.  I can identify with the fear but you must be in a different place right now.  Do your best to turn your attention to things you enjoy while you wait for the preliminaries to play out.  Good luck on the BC board.  You are one of us, so don't hesitate to call on us to keep you company.  Best wishes, Oldbeauty

BluebirdOne

Primavera said:

Well...a new cancer now

I told the lung doctor I didn't want to have that biopsy yet, until I get a second opinion. She said they would call in October.

I went to get a mammogram and they wanted extra views and then ultrasounds and after that biopsies of the left breast. My primary physician called me today to tell me that I have invasive ductal carcinoma, poorly differentiated.

I had a mass on left breast of 3.2cm and also a lymph node that was 1.1cm. That's what they biopsied last Friday.

I know someone here, doublewhammy (?) got both cancers at the same time. My uterine cancer was last year. I'm hoping things go well with this one, but it was really a blow when things were going well and I was trying to recover from the last year scare.

Thank you all for all the help you've given me here. Hoping the breast cancer forum is as good as this one, because I see a lot of the others don't ever answer you. I'm just scared today.

Primavera

I am so sorry to hear aboiut the breast cancer. Yes, I remember that there are a few ladies here who have had two cancers at once and hopefully they can give you some support. If the breast cancer board is not active, please find your way back here, we are here for you. Let us know how you are doing as you get more information. 

xxoo

Denise 

TeddyandBears_Mom

Primavera,

Primavera,

You have every right to be scared! And, I know you will fight it just like oldbeauty suggested. I hope they provide you a plan quickly so that you can get started kicking this darn thing to the curb. I'm sure you will feel much better once you know what to expect. Even if the breast cancer board is active, please come back and let us know how you are doing. We are here for you!

Love and Hugs,

Cindi

NoTimeForCancer

Primavera, I am sorry to hear

Primavera, I am sorry to hear about the news you got.  Dang it.  I think you will find there is lots of good support for breast cancer, but as Cindi asked, please be sure you let us know how you are doing.  

Primavera

oldbeauty said:

Fight the Fear!

Primavera, I'm so sorry to see this development.  I hope you can get in to see a good specialist asap to put your mind at rest and develop a treatment plan you can support.  Doublewhammy posted a few days ago on the Kaleena thread; maybe you can privatemessage her.  Donna Faye, I believe, also had breast cancer many years ago before the UC she's in treatment for now.  I only had a scare 3 years ago while in the midst of chemo.  Like you, I went for a routine mammo and then got called back for an ultrasound and a 3D image.  They told me I needed a biopsy; that I likely had an early stage ductal carcinoma in situ.  I was freaking out...and then it turned out to be benign calcifications.  So, I lucked out and you, alas, did not.  I can identify with the fear but you must be in a different place right now.  Do your best to turn your attention to things you enjoy while you wait for the preliminaries to play out.  Good luck on the BC board.  You are one of us, so don't hesitate to call on us to keep you company.  Best wishes, Oldbeauty

Thank you oldbeauty

I was being followed for calcifications on right breast already. Every six months, extra views and ultrasounds. Started last year in February, then I got another set in August. Both times it said "calcifications on right breast, probably benigh."

Then I was going back in February this year again. But my oncologist asked me to move from a radiology center where they do more than just breast, to the hospital breast cancer center, where they only do mammograms. I picked up my scans instead of going back to that other place and prepared to move to the hospital center, but then the pandemic hit.

I waited six months this time, so I went a year later to this new place. Going for two more biopsies on Monday. This time for the calcifications. The mass on left breast was either new or grew fast. Hospital said they would have followed calcifications with a biopsy anyway, not just checking every six months.

Forherself

Thinking of you

Primavera.  I pray for good outcome.  My Aunt had both uterine cancer and breast cancer.  She lived to 90 at home.   There is hope.  

BluebirdOne

Primavera said:

Thank you all

I don't know much right now. I am going to take a covid test Friday, then on Monday I'm going for a stereotactic biopsy on each breast for calcifications. I'm praying at least those are benign.

My primary physician moved fast today and she made me an appointment for Sept 3 with a breast surgeon and he should have the results of the Monday biopsies before I go see him.

Thanks for the help.

let us know what the Monday biopsy results are, please

And anything else! We are here for you. 

xxoo

Denise 

Primavera

Thank you Denise and Forherself

I'll let you know about Monday. I think the news will probably come from the surgeon I'll meet three days later, or perhaps my primary physician will call me again.

I had the covid test today. It wasn't bad at all.

Primavera

Thank you all

I don't know much right now. I am going to take a covid test Friday, then on Monday I'm going for a stereotactic biopsy on each breast for calcifications. I'm praying at least those are benign.

My primary physician moved fast today and she made me an appointment for Sept 3 with a breast surgeon and he should have the results of the Monday biopsies before I go see him.

Thanks for the help.

Primavera

Some news

I had the stereotactic biopsies on both breasts for calcifications after the ultrasound biopsies revealed the breast cancer on left.

I met with the breast surgeon 3 days later. I'm assuming he had the results for the stereotactic biopsies because he said right breast was OK. Not sure about the calcifications on left breast, but since it's already compromised, I didn't ask. I'll see the report online pretty soon.

Surgeon said he couldn't do a lumpectomy because the area is too "dispersed." He wants me to have chemo first, then a mastectomy with immediate reconstruction. I'm seeing oncologist on Sept 15 (and also the plastic surgeon) and having bone scans, chest, abdomen and pelvis ct scans on the 16th.

I wonder how long I have before they send me straight into chemo. I'm scared of it, of course, but reading all the suggestions for icing feet and hands and the rest over this forum. The uterine forum has the most suggestions, I think.

I saw another post for the icing mits. I'm trying to get the booties, too. I read that Elasto-Gel had a recall. I think people got frostbite?

I would do what ZsaZsa did with the ice, but in the middle of this pandemic, they don't let any other people than the patient in the cancer center.

I'll know more once I see the oncologist.

BluebirdOne

Primavera,

Thanks for the update. Hopefully your oncologist will give you more clarity. Let us know how things work out for you and what they recommend. 

xx00

Denise