PET and CT Reports for Lung Cancer Management

Q: PET and CT Reports for Lung Cancer Management

Dear Koko： 1. According to the attached report, there is no deterioration, and we cannot determine the drug resistance issue based on the absence of deterioration; continuous observation is necessary. 2. The current report is indeed accurate. 3. An

Positron Emission Tomography (PET) and Computed Tomography (CT) Report

Here is the translation of the provided medical content:
The following is the chest computed tomography report from September:
Computed Tomography of Chest With and Without Enhancement Shows:
Techniques:
- From lower neck to liver level in 3-mm sections for non-contrast CT
- From lower neck to liver level in 3-mm sections for contrast CT
- Coronal (3mm) and sagittal (5mm) reconstructions are also performed
This study has been compared to the previous CT study on June 17, 2022.
Findings:
- Partial regressive change of subpleural consolidation in the upper right lower lobe (RLL) compared to the last images
- Partial regressive change of ground glass opacity in the medial RLL
- Stable 4mm nodule in the left lower lobe (LLL)
- Stable small lymph nodes in the left supraclavicular, right hilar, and mediastinal regions
- Some small but visible lymph nodes in the upper retroperitoneum
- Stable right renal cyst
- Hypodense lesions without enhancement in the right lobe of the liver, possibly cysts
- No definite pneumothorax.
- No definite pleural effusion.
- No definite pericardial effusion.
- Patent main pulmonary trunk and branches, no obvious thrombus noted.
- No definite double lumen, intimal flap, or medial displacement of the aortic wall suggesting aortic dissection.
- No definite adrenal mass.
- No definite hydronephrosis.
- No definite bone destruction.
- Kindly note that subtle mucosal lesions could not be well evaluated on routine CT.
IMP:
- Partial regressive change of subpleural consolidation in the upper RLL compared to the last images
- Partial regressive change of ground glass opacity in the medial RLL
- Stable 4mm nodule in the LLL
- Stable small lymph nodes in the left supraclavicular, right hilar, and mediastinal regions
The following is the PET scan report from October:
PET Scan:
Indication: Right lower lung cancer with hilar encasement status post-target therapy.
Procedure: The patient was injected intravenously with 376 MBq of F-18-fluorodeoxyglucose (FDG) after fasting.
Blood glucose level was 107 mg/dl at the time of injection.
A non-contrast-enhanced CT scan was performed initially, followed by a PET scan obtained from the top of the skull to the knees.
CT imaging was performed for attenuation correction and anatomical localization only.
Content:
1.
There is a focal area (about 1.4cm) of increased uptake of radioactivity in the right pulmonary hilar region (SUVmax 10.0).
2.
Focal areas of mildly-to-moderately increased uptake in the subpleural consolidations over the RLL lung (SUVmax ~3.2).
3.
Physiological FDG uptake and accumulation in the brain, tonsils, salivary glands, heart, liver, spleen, gastrointestinal tracts, and genitourinary tracts.
4.
No definite abnormal FDG uptake can be demonstrated elsewhere.
Impression:
1.
An FDG-avid lesion in the right pulmonary hilar region, possibly residual tumor or lymph node metastasis.
2.
Moderate FDG avidity in subpleural consolidations over the RLL lung, likely indicating inflammation.
I was diagnosed with stage 3B lung adenocarcinoma in March of this year and am currently undergoing treatment with Anlotinib.
I have the following questions:
1.
Based on the reports above, has my condition worsened? Is there drug resistance?
2.
Does the PET scan report indicate that there are no brain metastases, bone metastases, or metastases to other organs?
3.
Some say that PET scans cannot detect brain metastases; is this true? If so, since I had an MRI of the brain in March that showed no metastases, is it still necessary to perform one?
4.
Is surgery recommended?
5.
Thank you for your response, Doctor.

Ke Ke, 40~49 year old female. Ask Date: 2022/10/21

Dr. Huang Yiwen reply Pulmonology

Dear Koko:
1.
According to the attached report, there is no deterioration, and we cannot determine the drug resistance issue based on the absence of deterioration; continuous observation is necessary.

2.
The current report is indeed accurate.

3.
An MRI of the brain is more precise; if there are no symptoms, follow-up can be done in a year, but if symptoms arise, immediate arrangements must be made.

4.
Surgery is not recommended at this time; lymphatic clearance is challenging, and multiple departments at Changhua Hospital are concerned about you.
Please continue to discuss with your attending physician.

Reply Date: 2022/10/21

More Info

Understanding PET and CT reports is crucial for managing lung cancer effectively, especially when interpreting findings that may indicate disease progression or response to treatment. Based on the reports you provided, let's break down the findings and address your questions.

1. Interpretation of the Reports
CT Report Findings:
- The CT scan shows partial regressive changes in subpleural consolidation and ground-glass opacities, which suggests some improvement or stabilization in those areas compared to previous scans.
- The stable 4mm nodule in the left lower lobe (LLL) and stable small lymph nodes in the supraclavicular and mediastinal regions indicate that there has been no significant change in these areas, which is generally a positive sign.

- The report does not indicate any new or worsening conditions such as pneumothorax or pleural effusion, which is reassuring.

PET Report Findings:
- The PET scan shows a focal area of increased uptake in the right pulmonary hilar region (SUVmax 10.0), which is concerning for residual tumor or lymph node metastasis. This is a significant finding, as higher SUV values typically indicate more aggressive disease.

- The mildly-to-moderately increased uptake in the subpleural consolidations over the right lower lobe (SUVmax ~3.2) suggests inflammation rather than malignancy, but it warrants further investigation.

2. Disease Progression and Resistance
Based on the findings from both the CT and PET scans, there is a concern regarding the increased uptake in the right pulmonary hilar region, which may indicate disease progression or residual disease. The stable findings in other areas suggest that while some aspects of your condition are stable, there is a potential area of concern that needs to be addressed.

Regarding drug resistance, the presence of a high SUV in the hilar region could suggest that the tumor is not responding adequately to the current treatment (Anlotinib). It is essential to discuss this with your oncologist, who may consider adjusting your treatment plan based on these findings.

3. Metastasis Assessment
The PET scan did not show any abnormal uptake in the brain, bones, or other organs, which is a good sign. However, it is important to note that while PET scans are sensitive, they are not infallible. Brain metastases can sometimes be missed, especially if they are small or not metabolically active. Since you had an MRI of the brain in March that showed no metastasis, it is likely that there are no brain metastases currently, but your oncologist may recommend follow-up imaging based on your overall clinical picture.

4. Surgical Consideration
The decision to proceed with surgery depends on various factors, including the overall health of the patient, the extent of the disease, and the response to current treatments. Given the findings of a potentially residual tumor in the hilar region, surgical intervention may be considered, especially if it can be done safely and if it may improve outcomes. This decision should be made in consultation with your surgical oncologist and the multidisciplinary team managing your care.

Conclusion
In summary, while some aspects of your condition appear stable, the increased uptake in the right pulmonary hilar region is concerning and should be further evaluated. It is crucial to have an open discussion with your healthcare team about the implications of these findings, potential treatment adjustments, and the role of surgery in your management plan. Regular follow-up imaging and assessments will be essential in monitoring your condition and guiding treatment decisions.

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