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New to Site: SUV max scores for lung nodules and lymph nodes?
Husband, 59 yrs old, felt off from a long-lasting summer sinus infection, about a month ago, got a heart/lung CT scan. Shocked to discover he has 2 lung nodules in upper right and 1 lower left, all just over 1 cm. The lower left lung nodule is spiculated. Because hubby is sensitive to allergies, occasional asthma attacks, and that recent sinus infection (with drainage and coughing), pulmonologist said the right lung nodules might just be inflammation, and to wait a month for inflammation to recede, then get a PET scan.
Hubby recovered from the sinus infection, now feels fine, no breathing symptoms or discomfort. Got the PET scan last week, all nodules do have mild hypermetabolic activity, SUV max scores of 2.7-2.9. But also, several enlarged thoracic lymph nodes (1.1-1.5cm), with SUV max of 6.1, 7.3 right paratracheal, 8.0 left hilar. Is this lymph node situation indicative of likely malignancy metastasis? I am just reading the report and looking up the terminology, etc. and this is what I am seeing.
We see pulmonologist again in a few days to discuss PET scan results, biopsy possibilities, etc. We are trying not to freak out like we did when we first got the CT scan results (ok, I am def. freaking out inside, just not in front of him), but this seems bad, no? Nodules with hypermetabolic activity in both lungs, lymph node activity on both sides, what are we likely facing here? [I would love get some insight as to what questions to ask the Dr., also maybe to hear a story from someone with similar scan results who is doing fine.]
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The American Cancer Society published this helpful list.
https://amp.cancer.org/cancer/types/lung-cancer/detection-diagnosis-staging/talking-with-doctor.html
Welcome to Mayo Connect @lbucky. I'm glad that you found us, but sad that you are facing this difficult time. Ugh, it's never easy. Try to focus on what you know now, not what might be true. Lymph nodes can certainly react and show higher uptake values than the nodules for an infection or other irritation. The next step is likely a biopsy where they can examine the cellular level of the lymph node fluid or the nodule itself.
I've had a cancerous mass (in 2020), and a fungal nodule (in 2023). Both showed as active on the PET scans, both had lymph nodes with uptake also (the values from the lymph nodes for the fungal nodule were over 7). Only a biopsy confirmed that the 2023 nodule was actual fungal in nature, and not a recurrence of the lung cancer.
Did you have the appointment with the pulmonologist yet? How did that go? Are they able to biopsy the nodule or the lymph fluid (sometimes it can be difficult due to the location of the nodule or the health of the patient)?
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3 ReactionsLisa, thanks for your comments. Just saw pulmonologist today, biopsies scheduled for Friday. It sounds like all nodules and active lymph nodes are in areas difficult to reach, so only getting tissue from one nodule (lower left) and one lymph node(upper right).
@lbucky, Great that he is on the schedule, and can start moving forward. I'll be thinking of you both.
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1 ReactionHi @lbucky, how are you and your husband doing? Any update?
Lisa, I attended the World Conference on Lung Cancer at the beginning of this month and learned the best question to ask your doctor about upcoming treatment. Like all good questions, it starts by asking yourself a question: What are your treatment goals?
A person with a 12-year-old daughter and a 10-year-old son might strongly desire to see them graduate high school. Such a person could decide to ask their doctor to kill this thing inside as thoroughly and quickly as possible; side effects be damned!
At the other extreme, a 78-year-old patient who learns that aggressive treatment would mean they have to move out of their home and into a retirement home might decide to seek the most comfortable treatment that allows them to remain in their home.
First, you and your husband should decide on your treatment goals. Express these goals to your doctor and ask what his or her plan is to help you achieve them. Hopefully, that's the beginning of a productive conversation.
I sincerely wish you and your husband all the best. I was first diagnosed when I was 58. I'm still working full-time, helping NASA return people to the moon, and doing a lot of yard work after our recent stormy weather! And be sure to take care of yourself. Being the caregiver is also tough.
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1 ReactionI just read your story. Pls keep us posted on your husband.Lots of great support and info here.
Update: got biopsies last Friday, getting results Tuesday. Samples were taken from left nodule ( which is smaller than originally thought, .8mm not 1.2), left hilar lymph, a couple from right paratracheal lymph nodes, and some saline lavage fluid. Still waiting, been waiting to find out what he has since end of August when we first got the news. Any advice on what to remember to ask if we have to discuss treatment? I like the discussion about health goals. Also, we are ready to go to Minnesota for treatment/2nd opinion, how does that work with our local doctors? We already send all imaging and reports to Mayo for his file up there.
First, I suspect it depends on what your insurance allows you to do. If you are allowed to self-refer etc. I self-referred to Mayo as soon as I saw the results from my CT and PET scans. I set up a Mayo account and told my local pulmonolgist to send everything. Mayo said it was 90 percent cancer and in my case did biopsy and surgery in one sitting.
@lbucky, patients can self-refer to Mayo Clinic or have their physician make the referral. You can find out more here: http://mayocl.in/1mtmR63
Many Mayo Clinic patients go to Mayo for complex and serious illness, while maintaining a relationship with a local non-Mayo physician. So, there are many options on how that can work. I've done a little bit of both.
I'm assuming that you have received results of the biopsies by now. How are you both handling the news?
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