[Joan M]

Hi to all my sisters ... and brothers,

On Jan. 6 I had my second follow-up PET/CT to the lung radiofrequency ablation I had in mid August, and I'm wondering what you think.

The first follow-up in mid Sept. was what the intreventional radiologist expected, but the second follow-up is inconclusive as to a recurrence. The rest of the scan was nonremarkable (yippee!).

Three people weighed in on the results. Besides the staff radioloigst, the films were also read by the interventional radiologist who did the procedure and a pulmonologist. All agreed that it's difficult to determine the difference between inflammation due to the RFA and a recurrence.

Also, I had a wedge resection 1 1/2 years prior the RFA, so there was a lot of scarring and fibrosis due to the surgery. The RFA was treatment for a recurrence in the surgical area.

There's a whole lot of fireworks going on, according to the second report.

The first follow-up report said that the area ablated had an SUV of 1.9 (as opposed to 3.0 prior to the RFA). The second report showed 6.0. There are also two other puntate areas in the vacinity of 3.0 and 2.8. But they have no correlation on the CT part of the scan (also, I was given a CT contrast medium to drink, which is usually not the case for other PET/CTs I've had).

I also have two dilated bronchi with hypermetabolic activity seen along the length of the bronchiectatic segment, and a left hilar lymph node with an SUV of 5.1. The lymph node size was not noted.

My oncologist is concerned about the lymph node. She is less concerned about the punctate spots because they do not correlate with the CT. That is, even though the spots lite up in PET, the CT showed nothing there physically. (The guideline for lighting up in PET is 1 cm, even though something could light up under that size. But CT can show spots as small as 2 mm.)

Here's the report's impression:

1. New bronchocele and bronchiectasis in the left uper lobe at site of prior RFA associated with increased FDG update.
2. Increased metabolic activity in soft tissue inferiorly within the bronchocele is inderminate for the recurrent tumor versus chronic inflammatory change or mycetoma formation. Activity in left hilum is likely reactive change in the lymp node.
3. New inderminate faint foci in the extreme left apex and left subclavian region, requiring attention on follow-up.

Sorry to bog you down with all the details, but just in case anybody's interested in what all this meant to the staff radiologist.

I'm planning to add Tykerb. But my oncologist first wants to get the results of a brain MRI I had the other day, which was a follow-up requested by a neuro-oncologist I'm supposed to meet next week (this is not the regular follow-up by the radiation oncologist who zapped the tumor bed after the surgery, which is scheduled for March, but rather due to a suggestion my the brain surgeon to follow up with a neuro-oncologist).

The radiation oncologist did not recommend antibiotics, in the event of a lung infection for instance, or a biopsy, even though the procedure can be done if I want one. My oncologist did not recomment either of these, as well.

Therefore, I'm going to take a wait-and-see approach, and repeat the scan again in April, unless I have symptoms.

I do have one slight symptom. Sometimes in the morning I have a small cough that produces sputum which has to have a small amount of blood in it. Both the radiation oncologist and my oncologist know about this.

I'm very nervous about waiting another three months for the next PET/CT scan, as I usually don't wait.

Joan