New CT scan indicates changes: Can radiologist reports be different?

Posted by akfishinmom1 @akfishinmom1, Aug 26, 2021

Had a calcium CT scan that mentioned a 18mm subsolid nodule in incidental findings. New scan today says it grew from 2.2 to 2.4 and also said the solid portion grew too. First report made no mention of size of solid portion. Also a couple of new ground glass opacities mentioned that weren’t in the previous report. Plus one enlarged pretracheal lymph node that was not mentioned in previous report either. Wants new scan in 3 months because subsolid nodule concerning for low grade malignancy. Can radiologist reports be so different?

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@akfishinmom1

Can a radiologist determine if a subsolid nodule is low grade malignancy from a CT scan? The radiologist measured the solid portion at 5.5 mm and said it was concerning for low grade malignancy. He recommended a 3 month follow up Ct scan or Pet/Ct. is it possible for them to determine low grade from a CT scan?

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@akfishinmom1- Subsolid nodules (SSNs) refer to pulmonary nodules with pure ground-glass nodules and part-solid ground-glass nodules. I have no idea how low-grade cancer cells are found because they look almost like regular cells. Since the report of the CT scan picked this up I imagine that your radiologist's training and experience led him to this result. Three months is often given as the time that cells can make changes that will show up on a CT scan, depending on the kind of cancer. After that, he might determine that a biopsy is recommended.

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@merpreb

@akfishinmom1- Subsolid nodules (SSNs) refer to pulmonary nodules with pure ground-glass nodules and part-solid ground-glass nodules. I have no idea how low-grade cancer cells are found because they look almost like regular cells. Since the report of the CT scan picked this up I imagine that your radiologist's training and experience led him to this result. Three months is often given as the time that cells can make changes that will show up on a CT scan, depending on the kind of cancer. After that, he might determine that a biopsy is recommended.

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So with your background do you know how small a nodule a Pet scan can show uptake. Based on comments it’s too small for a biopsy and the radiologist recommended 3 months for Pet scan. It will only be 2 weeks since scan. Am I jumping the gun for Pet scan? Pulmonologist is not available and not much help in decisions honestly.

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@merpreb

It sure does.

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@akfishinmom1 @lewismustard @merpreb I was also thinking about the same about the competency of the radiologist who read it. I have a good friend who had treatment at John Hopkins but follow-up scans done at a small local hospital, planning to send them on if significant. Unfortunately, the locals didn't notice something significant. I've been going back to Mayo for mine for just that reason.

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I just received my Pet scan results that showed Hilar lymph node on the right where the subsolid nodule is with a SUV maximal of 4.2 with a aortopulmonary lymph node maximal SUV of 3.8. Maximal SUV in left Hilum is 3.5. Received an email from pulmonologist saying we should look at a biopsy of Hilar lymph node but no mention of the other areas. They were not mentioned in the impression only concern of the Hilar node which the radiologist mentioned was mildly elevated. The actual nodule only showed SUV of 1.97. Again mention of low grade primary lung neoplasm. I read anything over 2.0 could be indicative of malignancy. If they do a biopsy they would they look at the other areas of elevated SUV too? It appears the pulmonologist just looks at the impression and skips over the other Information. Impression did say no metastatic disease is seen to the neck, abdomen or pelvis.

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Just received results from Pet Scan which the radiologist in the impression said SUV max was mildly elevated at 4.2 for Hilar lymph node and also for groundglass opacity which was 1.97 concerning for low grade neoplasm. Also with autopulmonary window lymph node maximal SUV at 3.8 and maximal SUV in the left Hilum at 3.5 but these were not mentioned in the impression. Why would the radiologist not mention the other activity in the impression too? No pathologic adenopathy seen by size or morphology. Pulmonologist wants to biopsy the hilar lymph node but again no mention of the other activity. I guess he didn’t read the whole report, just the impression section.

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@akfishinmom1

Just received results from Pet Scan which the radiologist in the impression said SUV max was mildly elevated at 4.2 for Hilar lymph node and also for groundglass opacity which was 1.97 concerning for low grade neoplasm. Also with autopulmonary window lymph node maximal SUV at 3.8 and maximal SUV in the left Hilum at 3.5 but these were not mentioned in the impression. Why would the radiologist not mention the other activity in the impression too? No pathologic adenopathy seen by size or morphology. Pulmonologist wants to biopsy the hilar lymph node but again no mention of the other activity. I guess he didn’t read the whole report, just the impression section.

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@akfishinmom1, I moved your latest post back to the earlier discussion you started so that people can see the whole story.
Have you had a chance to review the scan results with your oncologist yet?

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@colleenyoung

@akfishinmom1, I moved your latest post back to the earlier discussion you started so that people can see the whole story.
Have you had a chance to review the scan results with your oncologist yet?

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I do not have a oncologist yet. Going in today to discuss report with pulmonologist and talk about a biopsy.

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@akfishinmom1

I do not have a oncologist yet. Going in today to discuss report with pulmonologist and talk about a biopsy.

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What did you learn from your pulmonologist? What are the next steps?

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@colleenyoung

What did you learn from your pulmonologist? What are the next steps?

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I am going to have a biopsy on the lymph node and the subsolid nodule. The pulmonologist says he thinks he can do it. He wants me to have a CT lung scan the day of my consult appointment I guess to see if it’s possible,

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