Anyone have a PET scan light up s/p initial surgery (5 years ago R LL lobectomy and R UL wedge both stage 1 NSCLC) and it NOT be a recurrance? Been a long few months......
CT chest 5/12/23 showed mild increased thickening along the medial aspect of the suture line dating back to 2019, stable as compared to the 2022 exam. Mildly increased ground-glass changes adjacent to this thickening.
PET/CT 5/18/2023 demonstrated increased thickening and nodularity along the anteromedial aspect of the suture line since 2019 with heterogeneous mild FDG uptake, concerning for recurrent disease. Consider tissue sampling versus close interval follow-up to ensure stability. No FDG avid disease elsewhere in the body.
She underwent Robotic bronchoscopy with EBUS, lung biopsy on 6/13/2023. Pathology c/w: Lung parenchyma with focally minimal fibrosis, no explanation for a nodule is seen, no granulomata or carcinoma seen. Six additional levels of blocks A1 and A2 of the lung biopsy have been examined and again unremarkable fibrovascular tissue and lung parenchyma is seen. No inflammation, granulomata or neoplasm is identified. Right upper lobe, EBUS biopsy c/w: Rare atypical epithelial cells.
She completed a short course of antibiotic treatment - Azithromycin x 14 days. Repeat PET/CT 9/07/2023 demonstrated status post right lower lobectomy and right upper lobe wedge resection with postoperative changes. Unchanged thickening along the right upper lobe suture line. Stable medial nodular component measuring 1.8 x 1.6 cm with low FDG-avidity (SUV max: 2.2; previously: SUV max: 2.0). No new FDG avid lesion. No evidence of metastatic disease in the chest, abdomen, or pelvis.
Given the fact that she has a stable 1.8 x 1.6 cm FDG avid right medial nodular component, it is PET positive, with SUV 2.2, slightly increased from previous scan of SUV 2.0, we are concerned that the biopsy result might be false negative. We recommend that patient undergo a repeat navigational bronchoscopy with Dr. xxxx to ensure the accuracy.
