Annoying indecisive PET

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jts
Posts: 58
Joined: Sat Aug 24, 2019 3:07 pm

Annoying indecisive PET

Postby jts » Wed Apr 21, 2021 8:23 am

In December I had an abdominal MRI that revealed a 5 mm thing in my liver. The radiologist considered it a cyst, but from what I've been told, at that size it's really hard to classify. Looking at my old CT scans it had appeared in the last 4-6 months.

Last week I had a PET/CT scan. The radiologist in this case wrote something to the effect that it is not significant uptake at the site of the liver thingy. Looking at the scans myself, I have to say that the spot of the liver thingy is the brightest spot in my liver, going across multiple slices, and in all the scan directions.

So if the scan showed no heightened intensity at the liver thingy, that would be great! If it showed decisively higher intensity, that would be second best IMO, because then we could talk about treating it. But instead I've got this result where I feel pretty sure it's malignant, but is just too small to show enough intensity on the scan, and we have to wait, and PET scans are not so easy to get.
Male 42 — stage IV RC
NRAS mutant - KRAS, BRAF wt
08/2019 DX 6 cm long tumor
09-10/2019 Chemo-radiation
12/2019 TME Surgery, clear margins, 7/16 nodes positive
Pathology: ypT3 ypN2b M0
01-06/2020 - FOLFOX
CEA only goes up during chemo: 2.4 --> 6.2
07/2020 6 mm tumor in lung, was growing fast during chemo
09/2020 VATS
01/2021 new 5mm cyst in liver, CEA continues to increase --> 8
06/2021 CEA down to 6. Cyst not visible anymore.
05/2023 CEA fluctuates between 4 and 6. Scans have been clear.

boxhill
Posts: 789
Joined: Fri Apr 06, 2018 11:40 am

Re: Annoying indecisive PET

Postby boxhill » Wed Apr 21, 2021 10:48 am

According to what my onc tells me, that is too small to be accurately read by a PET.

I have had a little liver thing about that size ever since my first MRI in 12/18, after 12 rounds of folfox. It may have been there earlier, but it didn't appear on standard CTs. Immunotherapy eradicated my dangerous lymph nodes, but didn't seem to change the liver thing. Early on, I--like you--was really fretting about it, and wanted to have it removed. (It is subcapsular, so easy to remove.) My onc agreed to take it to the tumor board, and they said that no way would they remove it: the risk of liver injury, even if low, wasn't worth it, and some said it might not even be a met, or at least not a live met. Opinion as to what it was varied, but eventually the radiologists decided was that it was not active cancer. At that point, at least a year after it had first been seen, I relaxed.

I hope you get some resolution soon.
F, 64 at DX CRC Stage IV
3/17/18 blockage, r hemi
11 of 25 LN,5 mesentery nodes
5mm liver met
pT3 pN2b pM1
BRAF wild, KRAS G12D
dMMR, MSI-H
5/18 FOLFOX
7/18 and 11/18 CT NED
12/18 MRI 5mm liver mass, 2 LNs in porta hepatis
12/31/18 Keytruda
6/19 Multiphasic CT LNs normal, Liver stable
6/28/19 Pause Key, predisone for joint pain
7/31/19 Restart Key
9/19 CT stable
Pain: all fails but Celebrex
12/23/19 CT stable
5/20 MRI stable/NED
6/20 Stop Key
All MRIs NED

jts
Posts: 58
Joined: Sat Aug 24, 2019 3:07 pm

Re: Annoying indecisive PET

Postby jts » Thu Apr 22, 2021 7:30 am

boxhill wrote:According to what my onc tells me, that is too small to be accurately read by a PET.

Thanks. Yes, I asked about that, but my onc recommended to go ahead and do it (the PET scan).

Before corona it was common for the radiologists here to chat for a couple minutes about the scan and point out what they saw and answer questions. But sadly now I just get the report after a couple days. I'll have to ask the oncologist to look at the scan and give me some idea what's reasonable.

I had my wife (who does not know where the cyst is, or even which organ is the liver) to scroll through the PET slices. She immediately picked out the bright spot, which tells me I am not just me seeing things in the noise. Just that the intensity of the signal is below an arbitrary threshold. It's like they don't take into account the fact that the hot spot persists across multiple slices of the scan, which is not the case for the noise. But it really stands out to your eye when scrolling through.
Male 42 — stage IV RC
NRAS mutant - KRAS, BRAF wt
08/2019 DX 6 cm long tumor
09-10/2019 Chemo-radiation
12/2019 TME Surgery, clear margins, 7/16 nodes positive
Pathology: ypT3 ypN2b M0
01-06/2020 - FOLFOX
CEA only goes up during chemo: 2.4 --> 6.2
07/2020 6 mm tumor in lung, was growing fast during chemo
09/2020 VATS
01/2021 new 5mm cyst in liver, CEA continues to increase --> 8
06/2021 CEA down to 6. Cyst not visible anymore.
05/2023 CEA fluctuates between 4 and 6. Scans have been clear.


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