PET negative solitary pulmonary nodules
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PET negative solitary pulmonary nodules
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What do you do with PET negative solitary pulmonary nodules? If they're more than 1cm diameter in short axis, a PET should be sensitive enough to pick up malignanct change, but it's only of the
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Cat:OpenClinicalForum:8114d353-b41b-4a03-b052-dc009589d5cfDiscussion:94e9fd4b-40fd-4bcc-a947-d1f748ec2532
Forums » Open clinical » Respiratory medicine » PET negative solitary pulmonary nodules
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PET negative solitary pulmonary nodules
posted at 31/8/2011 4:30 PM BST
on bmj.com
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Posts: 512
First: 19/4/2010 Last: 22/2/2012 |
What do you do with PET negative solitary pulmonary nodules? If they're more than 1cm diameter in short axis, a PET should be sensitive enough to pick up malignanct change, but it's only of the order of about 90%, at best. So do you accept that 1 in 10 risk, and discharge without follow up? Or do you follow them up with 3 month, 6 month and 12 month CTs, as if they hadn't had the PET? Evidence vacuum. |
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Re: PET negative solitary pulmonary nodules
posted at 24/9/2011 1:02 AM BST
on bmj.com
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Posts: 1
First: 24/9/2011 Last: 24/9/2011 |
Find out the prevalence of disease in that population, then one can work out the predictive value of PET in that patient if you know their preoperative risk of disease. In addition involve the patient in the decision - sometimes if they dont wish the heart ache of repeat follow up, as long as the procedure is low risk (eg fit patient VAT wedge resection) surgery may be best - for diagnosis and treatment if isolated nodule. |
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Re: PET negative solitary pulmonary nodules
posted at 24/9/2011 10:59 AM BST
on bmj.com
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Posts: 1905
First: 10/3/2009 Last: 20/2/2012 |
Carcinoid tumours are FDG-PET negative. I have seen this a few times in the past year or so. They are also very vascular so if you do a CT-guided needle biopsy be prepared for this. Sarcoidosis, TB and most cancers are PET positive. I have had a few patients with sarcoidosis with hot nodules but with one of them being cold. The cold one was a carcinoid. Caveat emptor. Melanoma is hot. The occasional lymphoma is cold. Hamartomata are usually obvious by their sharp round edge on CT.
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Re: PET negative solitary pulmonary nodules
posted at 24/9/2011 5:30 PM BST
on bmj.com
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Posts: 1213
First: 7/3/2009 Last: 17/2/2012 |
What do you think about an incidental finding of a nodule in the middle lobe of RT lung that was 6 mm and after 3 months is 4 mm? Would you continue follow up at 6 months,12 months, etc?
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Re: PET negative solitary pulmonary nodules
posted at 5/10/2011 11:43 AM BST
on bmj.com
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Posts: 6
First: 5/10/2011 Last: 31/1/2012 |
yesn Response to Re: PET negative solitary pulmonary nodules: What do you think about an incidental finding of a nodule in the middle lobe of RT lung that was 6 mm and after 3 months is 4 mm? Would you continue follow up at 6 months,12 months, etc? Posted by yoram chaiter |
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Re: PET negative solitary pulmonary nodules
posted at 6/10/2011 11:15 PM BST
on bmj.com
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Posts: 512
First: 19/4/2010 Last: 22/2/2012 |
In Response to Re: PET negative solitary pulmonary nodules: Carcinoid tumours are FDG-PET negative. I have seen this a few times in the past year or so. They are also very vascular so if you do a CT-guided needle biopsy be prepared for this. Sarcoidosis, TB and most cancers are PET positive. I have had a few patients with sarcoidosis with hot nodules but with one of them being cold. The cold one was a carcinoid. Caveat emptor. Melanoma is hot. The occasional lymphoma is cold. Hamartomata are usually obvious by their sharp round edge on CT. Posted by Odysseus Welcome back, Odysseus. We recently referred a cytologically proven malignancy, PET very hot, lesion, for lobectomy, and it turned out to be Wegener's. A difficult consultation.... My practice is to follow up the PET negative nodules like I follow up any other nodule, rather than take the 'reassurance' of a negative PET. It's more work, obviously. |
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Re: PET negative solitary pulmonary nodules
posted at 7/10/2011 9:09 AM BST
on bmj.com
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Posts: 1213
First: 7/3/2009 Last: 17/2/2012 |
Maybe more work, but better follow up than be surprised later... How about MRI for follow up? Does it add anything apart from the fact that it does save repeated x-ray radiation? |
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