[Joan M]

Maureen,

I'm sorry you're having this difficulty, especially after just relocating. And also having to deal with widely different opinions.

I had a solitary nodule in my left lung that turned out to be breast cancer, and here's a few things I learned from the experience.

What was the uptake value (SUV) of the PET? Was it 3.0 or greater, which could indicate cancer (it can also indicate an infectious process).

Did the PET scan have a CT portion (as in PET/CT scan)? If so, was there a nodule on the CT portion that correlated to where the PET lit up. Even though the scan is a nuclear test that emphasizes the PET portion, which measures the intensity of metabolic activity (hence the light), the CT actually looks at morphology (sort of like a mammogram that describes how a nodule or a cyst looks). It's also used for correlation purposes and gives a more precise location of the area that lights up.

If there was a nodule on the CT portion, how big was it? Was it described as spiculated? Spiculated nodules are suspicious for cancer. (I'm not sure what lobulated means in this context.)

How big was the area that lit up on the PET portion? The probability of a nodule lightening up decreases when the nodule is under 1 cm, but that doesn't mean it isn't malignant. In my own case, in 2007 a PET/CT showed a 9 mm nodule that lit up and looked malignant on the CT part of the scan. However, that same nodule showed up on the CT portion of a previous PET/CT, but it was only 5 mm and was not noted in the report since it was too small and didn't light up. That is, the PET/CT is a nuclear test, so emphasis is placed on whether anything lights up. My onc asked the radiologist to compare both scans, and sure enough, the same nodule was there in the previous scan six months earlier. She asked for the comparison to determine whether the nodule had been there and, if so, how quickly it had grown.

The size gives an indication of whether to proceed with a biopsy. If a suspected area is under 1 cm, it's difficult to get an accurate result. The radiologist using a CT guided biospy may end up not getting enough for any result. Or, in my case, for the nodule that was 9 mm the radiologist got a piece of it but the path report noted only adenocarcinoma. The problem was that both breast and lung cancers are adenocarcinomas, and there wasn't enough from the biopsy to distinguish them. I had only one nodule light up and having previously smoked, lung cancer could not be ruled out (and it's not treated the same as metastatic bc). However, my local onc had my breast cancer slides sent to the large cancer center to compare to the biopsy slides, and based on the comparison, the pathologist favored a diagnosis of breast cancer. When the nodule was surgically removed and tested, it was found to be breast cancer.

So, you might want to take some of this information into consideration in determining whether to proceed with a biopsy or to wait perhaps for another scan to see whether the area is growing. There's something called doubling time which shows the rate of nodule growh based on number of days over a period of time. It can be used to indicate whether a nodule might be malignant, benign or an infection.

I'm sending you a lot of hugs for comfort.

Joan