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, these are great questions to ask your specialist. It is possible that at the time of the previous scan, these findings were unremarkable and therefore not noted. I would be interested in what you learn from your specialist. When is your next appointment?

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I just had my appointment with pulmonoligist and he looked and said on the 2nd Ct scan the radiologist used the first scan and resized the nodule and then compared it to my second one. So based on that he said the subsolid portion grew less than a millimeter but the overall groundglass portion grew from 2.2 to 2.4 cm. The first radiologist measured the whole nodule at 18mm not 2.2. That’s a big difference. Very confusing. Also said there was no abnormal upper lymph nodes shown in partial imaging. But the pretrachael lymph node on the second scan showed as 8.8 on the short axis. Very concerning. These scans were done ar different facilities and the first one was for a calcium CT scan and second for lung scan.

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@akfishinmom1

I just had my appointment with pulmonoligist and he looked and said on the 2nd Ct scan the radiologist used the first scan and resized the nodule and then compared it to my second one. So based on that he said the subsolid portion grew less than a millimeter but the overall groundglass portion grew from 2.2 to 2.4 cm. The first radiologist measured the whole nodule at 18mm not 2.2. That’s a big difference. Very confusing. Also said there was no abnormal upper lymph nodes shown in partial imaging. But the pretrachael lymph node on the second scan showed as 8.8 on the short axis. Very concerning. These scans were done ar different facilities and the first one was for a calcium CT scan and second for lung scan.

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It can be so confusing. Thank goodness medical specialists are trained to interpret the differences in reporting that can happen between facilities and order new tests when necessary. I'm sorry to hear that a pretracheal lymph node is showing evidence of concern. What is the next step? Will it be biopsied or further tested?

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I have a PET CT scan in early September. It is the 5.5 mm sub solid portion the radiologist is concerned about for low grade malignancy. What sent my anxiety into overdrive was when the pulmonologist mentioned if the lymph node was involved it was stage 3 lung cancer.

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@akfishinmom1

I just had my appointment with pulmonoligist and he looked and said on the 2nd Ct scan the radiologist used the first scan and resized the nodule and then compared it to my second one. So based on that he said the subsolid portion grew less than a millimeter but the overall groundglass portion grew from 2.2 to 2.4 cm. The first radiologist measured the whole nodule at 18mm not 2.2. That’s a big difference. Very confusing. Also said there was no abnormal upper lymph nodes shown in partial imaging. But the pretrachael lymph node on the second scan showed as 8.8 on the short axis. Very concerning. These scans were done ar different facilities and the first one was for a calcium CT scan and second for lung scan.

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@akfishinmom1– Hello, it's nice to meet you. I am a lung cancer survivor and the Mentor for the lung cancer group. I have run into this problem and I have to say that it shouldn't be a problem. I am treated at the second top hospital in the US and my Lung Surgeon and Oncologist now wait until after the radiologist's report to make a finding and send me the actual report. No matter how clear the CT scan is, radiologists are trained to see and measure everything little thing that they are looking for that no matter how minuscule they are. Even if doctors sometimes brag that they are great at reading CT scans, unless they are in front of the screen and are trained to read scans they aren't as good as radiologists.

My Oncologist actually goes to the radiologist who reads my scans and looks at his screen and discusses things with him/her!

Scans also depend on the size of the slice (tissue slice that is captured) that the machine is programmed for at your hospital. The thickness of the tissue represented in each image slice can vary depending on the CT machine used, but usually ranges from 1-10 millimeters.
https://www.nibib.nih.gov/science-education/science-topics/computed-tomography-ct
If I were you, I would ask for an explanation of the differences in measurements. Also, the ground glass area can be made up of different types of tissues. Your specialist should explain this to you in a manner that you fully understand.

Computed tomography machines are set at different levels in different hospitals, and you had two different types of tests. Also, Lymph nodes can be swollen and not a danger. I have a couple of them.

I don't blame you for being confused. Is your specialist open to explaining things to you?

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@merpreb

@akfishinmom1– Hello, it's nice to meet you. I am a lung cancer survivor and the Mentor for the lung cancer group. I have run into this problem and I have to say that it shouldn't be a problem. I am treated at the second top hospital in the US and my Lung Surgeon and Oncologist now wait until after the radiologist's report to make a finding and send me the actual report. No matter how clear the CT scan is, radiologists are trained to see and measure everything little thing that they are looking for that no matter how minuscule they are. Even if doctors sometimes brag that they are great at reading CT scans, unless they are in front of the screen and are trained to read scans they aren't as good as radiologists.

My Oncologist actually goes to the radiologist who reads my scans and looks at his screen and discusses things with him/her!

Scans also depend on the size of the slice (tissue slice that is captured) that the machine is programmed for at your hospital. The thickness of the tissue represented in each image slice can vary depending on the CT machine used, but usually ranges from 1-10 millimeters.
https://www.nibib.nih.gov/science-education/science-topics/computed-tomography-ct
If I were you, I would ask for an explanation of the differences in measurements. Also, the ground glass area can be made up of different types of tissues. Your specialist should explain this to you in a manner that you fully understand.

Computed tomography machines are set at different levels in different hospitals, and you had two different types of tests. Also, Lymph nodes can be swollen and not a danger. I have a couple of them.

I don't blame you for being confused. Is your specialist open to explaining things to you?

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I did ask him about the difference in sizes and he looked thru the slides and showed me how he went back and sized the nodule based on his machine to the current scan I had. He also found a 10mm Pure groundglass nodule that the other radiologist did not report just like the swollen lymph node.No mention of the type of tissue the subsolid nodule looked like. Didn’t know to ask about that. I guess because the first scan was for a calcium CT score and not lung screening the radiologist didn’t feel the need to report on every little thing. Right now our hospitals are so overwhelmed with covid cases I can’t even get a pulmonary function test that he ordered. I guess the Pet/CT will show more. Thanks for your imput. I appreciate it.

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@akfishinmom1

I just had my appointment with pulmonoligist and he looked and said on the 2nd Ct scan the radiologist used the first scan and resized the nodule and then compared it to my second one. So based on that he said the subsolid portion grew less than a millimeter but the overall groundglass portion grew from 2.2 to 2.4 cm. The first radiologist measured the whole nodule at 18mm not 2.2. That’s a big difference. Very confusing. Also said there was no abnormal upper lymph nodes shown in partial imaging. But the pretrachael lymph node on the second scan showed as 8.8 on the short axis. Very concerning. These scans were done ar different facilities and the first one was for a calcium CT scan and second for lung scan.

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DEPENDS ON COMPETENCY OF PHYSICIAN. I have been a hospital CEO for 40 years

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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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@lewismustard

DEPENDS ON COMPETENCY OF PHYSICIAN. I have been a hospital CEO for 40 years

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It sure does.

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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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