CT Scan

Kaye2003 · September 2008

Hey guys. Its been a while since I posted. My husbands is still NED for crc. Thank God.

The reason I am posting today is because of my own lung scans. I posted the following on the lung boards and did get a response from a wonderful lady, but their board is not as active and I would love some advise from you guys if you don't mind and have the time. The post is:

I had a CT Scan done on March 25, 2008 and the results were:

“A few nodular densities, which are not definitely calcified, the largest measuring roughly 6 mm in the lateral aspect of the left lower lobe, partially calcified 4 mm nodular density lateral aspect of the right lower lobe and a non calcified 3 mm nodular density anterior aspect of the right middle lobe. Recommend correlation with chest x-ray findings if these are visible on chest x-ray. Recommend continued follow up with chest x-ray to document continued stability over a two year period. If not visible on the chest x-ray, consider follow-up chest CT in six month.”

"Consider follow-up chest CT in 6 months".

Sept 12, 2008 had the follow-up CT done and the results are:

No pneumothorax or effusion. 4mm left lower lobe nodule image 34, static. Bilateral upper lobe and apex emphysematous bleb formation. Multiple right midlung nodular opacities image 32 are also static, largest 5mm laterally. 2mm right middle lobe nodule image 37 is static. No hilar mass.

Continued follow-up at 6 month intervals recommended to confirm two year stability. The 5mm right midlung nodule described above is static but has slightly spiculated margins.

The first CT said:
6mm left lower lobe, (under impressions says: partially calcified)
4mm right lower lobe
3mm right middle lobe

Fridays CT said:
4mm left lower lobe
5mm right midlung, being the largest of multiple
2mm right middle lobe

I don't understand how the sizes are different and how I had a 4mm in the right middle lower lobe the first CT and now a 5mm right midlung on Fridays CT. If I am getting more nodule, shouldn't the ct have picked up all the old ones as well.

And can someone please explain what "spiculated margins" means.

The Rad told my doctor that he compared the two scans and for me not to worry and he would see me again in 6 months.

Please give me your opinions and advise. Naturally, I am concerned that this could indicate lung cancer in the future.

God Bless,
Kaye

taraHK · September 2008

I'm no expert
Hi Kaye,

I'm certainly no expert. But, having had three lung nodules (which did eventually turn out to be mets from my rectal cancer) I have done some reading/researching on lung nodules -- just on my own. I did learn that it is not at all uncommon to have nodules which turn out to be "nothing" (i.e. not cancer, not TB, not anything else sinister). Such things are apparently pretty common (who knew). The definition of "nothing" is no significant change for two years -- that seems to be consistent with what your doctors are telling you. The small size of your nodules means they probably wouldn't "light up" on PET scan even if they were malignant (which of course I hope and pray they are not). In my experience, spots have to be about 1cm for that (although that varies, lab to lab, I guess). And probably too small to biopsy -- that seems to be controversial anyway -- I was never able to get a successful biopsy of any of mine. "Watchful waiting" was what I was told -- when I had a teeny one that didn't initially appear to be a met. Of course waiting is a particular form of torture which we know all too well -- and waiting another 12 mos or so will be especially hard. I don't understand why the nodules are partially different this time -- maybe sensitivity of the CT? Is is possible for you to have a more in-depth discussion with the doc? Something else I tried -- instead of a biopsy -- was something called 'bronchial wash' (I think). It only works if the nodules are situated close to the trachea (?) and even then depends on some luck in being able to flush out enough cells. Also, it is a particularly unpleasant procedure. I had it unsuccessfully (that is, they did it, but I learned nothing). Again, I'm no expert on this -- just wanted to share my own experiences -- and to say that I am thinking of you, rooting for you -- and sending all best wishes your way -- esp that these are a big fat Nothing.

Tara

lisa42 · September 2008

CT scans and contrast
Hi Kaye,

I have learned that not all CT scans are the same. Your changed sizes may mean the sizes of the nodules really are different now, or it may mean that this CT scan was taken with either more or less contrast which can actually have more or less show up which can be measured differently. I also found that having different radiologists read the scans and write up the report can make a difference. I was dismayed to learn it isn't quite as an exact science each time as I had hoped it was. Not to discourage you, but just share what I was told when I, too, had different numbers with two CT's being compared & also with the CT portion of a CT/PET scan. Someone commented that they thought a nodule had to be about 1 cm to light up on a PET scan. Not always true- my recent PET scan (which I then started on chemo again following) was lighting up with my largest node being 8 mm & "several" other subcentimeter nodules also lighting up. That's another example of different radiologists writing it up differently- I wish they hadn't just stated "several subcentimeter nearby nodules"- I wasn't given any specific size- but they are all lighting up on my PET. This was a time span of three months, by the way, that my PET went from not lighting up to lighting up (the largest was then measured as 5 mm on the CT, but didn't show up on the PET in May- grew to 8mm in August & was then also lighting up). Advice: don't wait 6 months for another scan- I waited just the three & would have hated to see what it would have grown to if I had waited another 3 months.
Best wishes-
Lisa

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