ct , pet scans, ct/pet scans: what are people's experience of these re: enlarged nodes?

lindaprocopio said:

5 days after Doxil & now I think I can safely type!
Originally my oncologist said he didn't trust PET scans as much as CT scans, because when tumors are smaller than 1 cm (= 10 mm) the false-positive rate on a PET scan for tiny tumors can be as high as 45%. And so I just got CT-scans, as long as they were NED. But as soon as I had a CT-scan showing a couple enlarged lymoh nodes, coupled with a spike in my CA125, he ordered a PET scan. And I have been getting CT/PET scans ever since.

If the CT scan shows something larger than 10 mm (= 1 cm), PET scans are statistically accurate at diagnosing malignancy something like 97% of the time. So if you have something measurable on a CT scan larger than 10mm, a PET scan is a very accurate diagnostic tool. & my oncologist said that if you get a CLEAR PET scan, where nothing lights up, BELIEVE in it, as False NEGATIVES almost NEVER happen.

For UPSC, CT/PET scans should be covered by most insurances, if your oncologist makes the argument that this is similar to ovarian cancer. The CT-scan part shows the SIZE of the tumor and any change in size from the prior scan; the PET-scan part shows the metabolic activity and if a tumor larger than 1 cm lights up with an SUV of 3.5 or greater, there is a very good chance (97%) that this is a malignancy. Still, if you can, you want a needle biopsy to confirm the malignancy before you start taking chemo again for the results of the CT/PET, if it is safely do-able.

Was that what you were looking for?

yes, i mostly it was!

i did know quite a lot about the differences between ct and pet scan, but was very glad to learn your specific experience, linda. and, i was glad to know that there may be false positives, but not so many false negatives. because my enlarged para-arortic node is 1.4 cm, doctors are recommending a pet scan. they've been refused twice by my insurance, blue shield. my medical oncologist will do a physician-to physcian phone call, and seems fairly otomistic that blue schield will eventally approve the ct/pet. we'll see... will also depend on the numbers of my ca 125 in later november, i imagine. i am, i have to say, as i've said before, leery about doing a needle biopsy, and neither of my doctors has ever recommended one. mosly, i have reservations about disturbing it if is is malignant, because it will no doubt have a few malignant cells attached to it as it makes its way out. soo, guess i'll cross that bridge when i come to it. (the most knowledgable person at my chemo hospital is the charge nurse, and she, fortuitiously, took a look at my ct scan and said she doubted my node was malignant because it didn't have anything suspicious around it, no debris, or whatever, so she thought it was adhesions/scar tissue: "from her lips to god's ear."

the thread i'd been following also had a number of other posts by women recounting their experiences; some women's nodes dissolved on their own, others were false positive, others had decreased in size, without any intervening treatment--just time between one type of scan and another. so, i was hoping some of these other women might post again. the thread was only up a couplie of days before it was deleted presumabley because of a scammer.

hugs, maggie

upsofloating said:

Hi Maggie, I had lymph nodes
Hi Maggie,
I had lymph nodes enlarged per a CT and then light up on PET scan but two later resolved - without intervention. In rechecking my report, the SUV was only 1.3, 1.5, 1.9 on the three nodes: 2 in lower pelvic area, one para-aortic - 1.7cm x 1.1 cm). I noted this time that radiologist's interp was: suggests malignancy based on my history and location but rec was: follow and repeat study in 3 months.

Instead, my gyn-onc jumped on to port insertion and prep to start chemo asap! Freaked me out and made me think it time for last rites, lol. This was Jan/Feb, 2009. However he left the clinic and I chose to stay and change docs rather than follow him (for ins. coverage reasons). Recheck of ca125 for new doc revealed back in normal range (no treatment) and new CT scan in Jun 09 showed lymph nodes shrinking or not visible. However by Sept 09 PET/CT the para-aorta node had enlarged (2.3 cm)and new SUV was 9.5 (up from 1.5), plus another nearby with SUV of 12.1(2.6 cm), biopsy showed malignant cells that matched original cancer slides.

I didn't have another PET until a few weeks ago - no increased uptake in any of the nodes, recent CT scan had showed both para-aortic nodes only 0.8 cm. I had 2 rounds of Doxil in early 2010, and 4 rounds of Gemzar in spring/summer. So resolution this time followed treatment.

I do think earlier enlarged groin area nodes may have been due to a bladder infection a few weeks prior. This could also have been cause for spike in ca125. Now had I had treatment maybe it would have zapped cells that showed up in para-aortic nodes, but I'll never know. I'm just enjoying current clean CT/PET results for now :-)

Hope this helps! -- Annie

annie, thanx for your response

it was very helpful. so glad that doxil and gemzar were so successful. interesting how your nodes resolved by themselves, then enlarged again. anyone ever explain how that could have happened? you said 2 rounds of doxil, how many actual infusions was that? and 4 of gemzar. were there actually 2 and 4 infusions only? did you have many side effects from either?

i don't think it makes much sense to second guess ourselves; we always make the best decisions that we can when we are faced with something requiring us to make choices when we don't really have all the information, doctors don't either. so, glad you're enjoying your current clear ct/pet results--may these results last for many, many years.

sisterhood,
maggie