I am new with questions

mat2000

Just had a Monarch Robotic assisted bronchoscopy for a 1.7 nodule lower Right lung and a lymph node.

Dr called he missed getting tissue of the nodule bc results so normal tissue. Results on lymph node next week but doen't think it is anything.

Scheduled me for needle biospy when I recover from this.

Another interventional pulmonologist says location too dangerous for a needle biospy. A oncologist on the lung screening board wants to skip the biospy and do surgery.

What the heck do I do?

Sharon5922

Hello.

I've been there on the risky needle biopsy. First off the result of the needle bopsy was negative. BUT. They popped my lung doing it. I was in the hospital for 5 days trying to recover from that. Second off, the negative result was false. My nodule was not big enough to biopsy at 9mm. This gave me false confidence and I was extremeley angry at the doctor that told me either I had a needle biopsy or he would remove my lobe. This doctor specialized in bronchoscopy and he stated he could not reach this area so he essentially gave me a forced choice. I think he really wanted to cause me some pain to force me to quit smoking. He bullied me. He did not tell me the risks or the alternatives.

I had two other alternatives.

One was to monitor it through CT scans every 3 months to watch for growth. CT imaging can detect the cancer. If it grows or glows chances are it is cancer. Trust me. I learned this the hard way.

The next alternative is a surgical wedge biopsy. (which my initial specialist does not do, so he did not inform me of VATS options) This removes a smaller section of the lobe that contains the nodule. The nodule can then be biopsied for cancer. This seems invasive, but in my case, it would have been a blessing to have a smaller wedge removal of the nodule removed before it's growth accelerated and it turned cancerous... than to wait the 16 months where I became complacent over that "negative for cancer" needle biopsy.

I have recently had the lobe removed as the small nodule tripled in size in 18 months. It was almost certainly cancerous and the tumor/nodule was biopsied during the surgery to confirm the cancer. Keep in mind that sometimes a complete diagnosis does not exist until you have surgery.

You have options and you should check them out.

mat2000

https://csn.cancer.org/discussion/comment/1703195#Comment_1703195

Thank you so much for replying.

I have had the nodule scan every 3 mon for a year and it grows everytime. it is 1.7cm x 1.7cm. Pet scan shows SUV value at 6. So it lights up.

Disapointing Monarch RAB Dr missed the nodule. The lymph node he took came back benign.

Don't want to play whack a mole with needle biospy. At this point want it taken out with good margins and then we will know what it is.

How did you do with VATS? Was that only for diagnostics or also to remove the lobe.

What was your specific diagnose? What Stage?

Did you do radiation and chemo?

What do they do for followups? Scans every 3 mon?

How do you feel now?

Sharon5922

To answer some more questions

I had early stage lung cancer adenocarcenoma, which tend to double every 260 days. With Stage 1 - 3a and no lymph node involvement, the cadillac plan for cure - where there is no lymph node involvement, is to remove lobe. You can also have wedge resection at this stage (stage 1) but the odd are a few percent points lower and there is less stats on people doing this, so full lobectomy remains recommendation. My surgeon removed 14 lymph nodes for review. No lymph node involvement.

Keep in mind, a "surgical cure" is not guaranteed even though "surgery is the cure," one must survive 5 years before being considered "cured."

I do not have chemo or any adjuvant therapy scheduled because there was no lymph node involvement in my case. I knew and so did doctors that odds were high on this being cancer, so I was prepared for the lobectomy when I went under for the surgery.

(The agreement was that once they got in they would diagnose the tumor prior to removal of lobe or other action and if it was noncancerous do a wedge resection. It appears with this surgeon, wedge resection is outpatient. I can't imagine it being that easy but that is the norm for it apparently.)

My follow-ups are to be CT/PET with contrast scans every three months for one year. If that remains clean, then every 6 months until 5 years have passed and I am considered cured.

My doc gave me a good prognosis for stage one. I think he wants to remain positive. I do know from research, if it returns, it will be in first 2 years.

It sounds like from the size of your "nodule" you are stage one. You would be very lucky to have the diagnostic wedge resection and be stage 0 or benign and not require lobectomy as this spares more of your lung and breathing. I would do this for diagnostics and some outfits do use this as diagnostic procedure.

I can say that with having a lobectomy my breathing is relatively fine (mine was upper right) and that is not really an issue. I was breathing fine within hours of surgery. I am still recovering from the surgical cuts of the VATS at one month (4) and there was a tube down my trachea which was not pleasant and lowered my voice a bit but pain subsides on that. I did have a nerve block and I don't know how they did it but I highly recommend one if you get a lobectomy. I had my surgery done at a cancer treatment center affiliated with a university as a teaching hospital. These type of cancer centers typically have access to most progressive treatments.

I found my own second opinion treatment pratice and then my general physician referred me to them so my insurance would cover it.

Please check back in and let me know what happens over the next few weeks.

Good luck.

mat2000

Had vats surgery 2/16 to remove unknown 2.1cm nodule RLL. Surgeon did segment, said he got it all, got good clean margins. Love 5% cap vs 25% gold standard lobe removal. Says more surgeons doing that when possible. Waiting on full pathology on lymp nodes and other small nodules removed.

Very painful. 10 days post op they are allowing me to do medrol dose pak to reduce high level of inflammation. Finally getting some reĺief. My restong heart rate went from55 to 75. Starting to go back down.

They tried to discharge me hours after surgery. Someone prematurely removed tape from my eyes. Got very bad adbrasions, very painful. Blinded for a day. O said you are releasing a 68 yr, blinded who lives a long. You are crazy. Pre Op visit told us and wrote 2 days in hosp . Driver, caregivers arranged based on that ongo. They hassled me tje next day as well. Told them if they discharged me I would appeal and it takes 3 days to adjudìcate . I left day 2. Very difficult at home. Cleveland clinic says 3-4 days. Great surgeon but rest of it was crazy. Have to go Mar 1 followup to get 1 stitch out and report. Nurse change to have their team close to me do it. But dr cancel. Too far, too painful to do rountrip. Will message him alternative plan and ask if my attorney can assist on this matter. They can send final pathology reports in my chart. God is good.

mat2000

Pathology Report Case:

Specimens: A) - Lobe, Right Middle, right middle lobe wedge

B) - Chest, Level 7

C) - Chest, 12 R

D) - Lung, Right, Superior and medial segmentectomy. Freeze nodule and bronchial

margin.

E) - Lobe, Right Lower, Right lower lobe wedge

F) - Lobe, Right Lower, Right lower lobe wedge

G) - Chest, Level 8

H) - Chest, 4RFinal DiagnosisYour Value

A. Lung, right middle lobe, wedge resection:

Lung parenchyma with 1 benign intraparenchymal anthracotic lymph node.

 

B. Lymph nodes, level 7, excision:

1 lymph node negative for metastatic tumor.

 

C. Lymph nodes, 12 R, excision:

1 lymph node negative for metastatic tumor.

 

D. Lung, right, superior and medial segment, segmentectomy:

Adenocarcinoma, multifocal, dominant nodule measuring 2.5 cm acinar, lepidic, mucinous and papillary types, with multiple satellite nodules in close proximity to the dominant nodule, measuring 02.-0.5 cm. See comment

Bronchial and vascular margins of resection negative for carcinoma.

Focus of neuroendocrine cell hyperplasia.

One intraparenchymal lymph node, benign.

 

E. Lung, right lower lobe, wedge resection:

Focus of alveolar cell hyperplasia.

Focus of meningothelial nodule.

 

F. Lung, right lower lobe, wedge resection:

Lung parenchyma with focal nonspecific lymphoid aggregate, benign.

 

G. Lymph nodes, level 8, excision:

2 lymph nodes negative for metastatic carcinoma.

 

H. Lymph nodes, 4R, excision:

Four lymph nodes negative for metastatic carcinoma

CommentYour Value

Multiple satellite nodules interpreted as and favored to be intrapulmonary mets with aerogenous spread.

 

Immunoprofile of the tumor:

CK7 Positive

CK20 Negative

CDX2 Negative

TTF-1 Positive (with patchy negative foci)

Napsin A Positive (with patchy negative foci)

 

Immunohistochemical analysis for PD-L1 was performed using the Ventana SP263 clone. 

 

Approximately <1% of the tumor shows membranous staining for PD-L1.

LUNG: RESECTION - All Specimens

8th Edition - Protocol posted: 6/22/2022

SPECIMEN

Procedure: Wedge resection

Procedure: Segmentectomy

Specimen Laterality: Right

TUMOR

Tumor Focality: Separate tumor nodules (metastases) in same lobe (pT3)

Tumor Site: Lower lobe of lung

Tumor Size:

Total Tumor Size (size of entire tumor): Greatest Dimension (Centimeters): 2.5 cm

Histologic Type: Invasive acinar adenocarcinoma

Histologic Grade: G2, moderately differentiated

Visceral Pleura Invasion: Present

Direct Invasion of Adjacent Structures: Not applicable (no adjacent structures present)

Treatment Effect: No known presurgical therapy

Lymphovascular Invasion: Present

MARGINS

Margin Status for Invasive Carcinoma: All margins negative for invasive carcinoma

Closest Margin(s) to Invasive Carcinoma: Parenchymal

Distance from Invasive Carcinoma to Closest Margin: At least: 0.5 cm

Margin Status for Non-Invasive Tumor: All margins negative for non-invasive tumor

REGIONAL LYMPH NODES

Lymph Node(s) from Prior Procedures: No known prior lymph node sampling performed

Regional Lymph Node Status:

: All regional lymph nodes negative for tumor

Number of Lymph Nodes Examined: At least: 10

Nodal Site(s) Examined: 4R: Lower paratracheal

Nodal Site(s) Examined: 8R: Para-esophageal (below carina)

Nodal Site(s) Examined: 12R: Lobar

Nodal Site(s) Examined: 7: Subcarinal

PATHOLOGIC STAGE CLASSIFICATION (pTNM, AJCC 8th Edition)

The suffix m (or a specific number) should only be used in the setting of multifocal ground-glass / lepidic nodules that histologically present as adenocarcinomas with prominent lepidic component or multifocal tumors of same histologic type that are too numerous for individual separate synoptic report and that are not better classified as intrapulmonary metastases (e.g. numerous carcinoid tumors). Multiple primary lung cancers showing different histologic type or different morphology based on comprehensive histologic subtyping are better staged as independent tumors without m suffix.

pT Category: pT3

pN Category: pN0Clinical InformationYour Value

Pre-op Diagnosis: Lung nodule [R91.1]

Post-op Diagnosis: Lung nodule [R91.1]

Microscopic DescriptionYour Value

A.

Received fresh intraoperatively for consultation and designated on the container as "right middle lobe wedge", is a 3.0 x 0.5 x 0.5 cm lung wedge. The staple line is removed and the specimen is frozen entirely. The intraoperative consultation diagnosis is, "LUNG PARENCHYMA WITH LYMPHOID AGGREGATE NODULE AND REACTIVE TYPE 2 PRE-PNEUMOCYTES. NO DEFINITIVE MALIGNANCY IDENTIFIED", communicated to Dr. Bharat in operating room F32 by Dr. Yang at 1025 on February 16, 2023. The frozen section remnant is submitted entirely in A1.

 

B.

The specimen is received fresh labeled with patient's name, medical record number, and "level 7". It consists of 1 pink–tan lymph node candidate, 2.1 x 1.6 x 1.0 cm. The specimen is serially sectioned and entirely submitted in cassettes B1-B2.

 

C.

The specimen is received fresh labeled with patient's name, medical record number, and "12 R". It consists of a red–brown lymph node candidate, 1.3 x 0.9 x 0.4 cm. The specimen is bisected and entirely submitted in cassette C1.

 

D.

Specimen D is received fresh for frozen section analysis for designated as "superior and medial segmentectomy, freeze nodule and bronchial margin." It consists of a 44.9 gram lung segmentectomy specimen, 7.6 x 5.2 x 2.5 cm. The pleural surface is purple–gray, smooth and glistening with 2 irregular staple lines, 5 and 10 cm in length. The staple line are removed, and the underlying parenchyma is inked green. The specimen is serially sectioned demonstrating an ill-defined tan–gray, firm nodule, 2.5 x 1.8 x 1.5 cm. The mass is 0.8 cm from the nearest pleural surface, 0.5 cm from the parenchymal margin, and 1.2 cm from the vascular and bronchial margins. The remaining parenchyma is red–brown, soft and spongy. No additional masses or lesions are grossly identified. Photographs are taken for documentation. Representative sections are submitted in cassettes as follows:

D1 = representative nodule, frozen section remnant

D2 = bronchial margin, frozen section remnant

D3 = vascular margins

D4-D6 = remainder of nodule, to include nearest bronchial vascular margins and D5

D7 = uninvolved parenchyma

The frozen section diagnosis rendered by Dr. Yang for Dr. Bharat is "D1: LUNG ADENOCARCINOMA. D2: BRONCHIAL MARGIN, NEGATIVE FOR CARCINOMA" at 1214 on 2/16/23.

E.

Specimen E is received fresh for frozen section analysis for designated as "right lower lobe wedge." It consists of a pink–tan lung wedge specimen, 3.1 x 1 x 0.5 cm. The specimen is serially sectioned and entirely submitted for frozen sectioning. The frozen section remnant is entirely submitted in cassette E1.

The frozen section diagnosis rendered by Dr. Yang for Dr. Bahart is "FOCAL NODULAR PNEUMOCYTE PROLIFERATION AND BRONCHIALIZATION" at 1214 on 2/16/23.

F.

The specimen is received fresh labeled with patient's name, medical record number, and "right lower lobe wedge". It consists of a purple–gray, 0.2 g lung wedge specimen, 3.5 x 0.8 x 0.4 cm. The pleural surface is smooth and glistening with 1 irregular staple line. The specimen is serially sectioned demonstrating tan–brown, soft and spongy parenchyma. No masses or lesions are grossly identified. The specimen is entirely submitted in cassette F1.

 

G.

The specimen is received fresh labeled with patient's name, medical record number, and "level 8". It consists of 1 yellow–tan lymph node candidate , 0.9 x 0.7 x 0.5 cm. The specimen is entirely submitted in cassette G1, in toto.

H.

The specimen is received fresh labeled with patient's name, medical record number, and "4R". It consists of 1 yellow–tan possible lymph node, 2.5 x 1.9 x 1.3 cm. The specimen is serially sectioned and entirely submitted in cassettes H1-H3.

 

Collected on 02/16/2023 9:52 AM from Lobe, Right Middle (Tissue)

Collected on 02/16/2023 9:57 AM from Chest (Tissue)

Collected on 02/16/2023 11:20 AM from Chest (Tissue)

Collected on 02/16/2023 11:41 AM from Lung, Right (Tissue)

Collected on 02/16/2023 11:45 AM from Lobe, Right Lower (Tissue)

Collected on 02/16/2023 11:48 AM from Lobe, Right Lower (Tissue)

Collected on 02/16/2023 11:54 AM from Chest (Tissue)

Collected on 02/16/2023 11:54 AM from Chest (Tissue)

Resulted on 02/24/2023 5:08 PM

Result Status: Final result

Sharon5922

I am glad you got treatment!

The surgery is a bit rough and it does appear that hospitals kick patients out early. Quite frankly I think I was kicked out early due to post holiday COVID surge. I did okay at home alone and I hope you are doing okay as well.

I find it very interesting that you have had surgery to remove tumors and not the complete lobe. I will try to keep up on your progress. I hope you don't have to return for more surgery

Best of luck.

PS - I just read your followup.