SUV 2.0

[kri312]

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.

[RoyCastleHelpline Partner Ask the Nurse Roy Castle]

Hi Kri312

Sorry to read of your understandable worry and concern ,and for anyone that has had cancer, it is only natural to have the thought of what if it comes back.

It is encouraging that they have reported no evidence of metastatic disease and they are obviously going by the SUV going above 2 that would merit a repeat biopsy.

It is worth noting that in some research data, a raised SUV on scan can be contributed to infection/inflammation rather than malignancy. I have placed below a quote from one of the research papers:

"As such, many benign infectious/inflammatory processes will have substantial FDG uptake with a high SUV value, and conversely, many indolent or slowly growing malignant processes may have minimal uptake, and low SUV values. This is not to say, however, that using SUV thresholds for diagnosis is not of any value."

The only clear way to ascertain what is there, is for the recommended repeat biopsy. I am not sure if you are based in USA or UK , but you could discuss this with your lung cancer nurse specialist or oncologist.

We appreciate that this is an anxious time for you and hope you have the biopsy results soon., try and avoid looking things up in google as it can be inaccurate and not up to date. You are welcome to contact us if you would like to discuss anything, our ask the nurse helpline is 0800 358 7200 Monday to Thursday 0900-1700 and Friday 0900-1600, alternatively you can email us at [e-mail]

All the very best

The Roy Castle Support Team

[kri312 in reply to RoyCastleHelpline]

Thank you - I am in the US.