Lung and needle biopsy

[Atoq]

To those who had lung metastasis, did you take a needle biopsy before resection to exclude a new primary tumor?
Or given the CRC they were assumed to be metastasis?

Claudia

[Mercy110]

My mum didn't as her CEA has not go down after surgery and 2 rounds of xeloda. Onco assume there are mets in her lungs as nodules grew.
Hope this help.

[NedPlease]

I did not have a biopsy as it was so small (7mm) that a radiologist friend told me a biopsy might be inconclusive and a top notch thoracic surgeon was willing to remove it via VATS. I wanted it out rather than watching it. Pathology confirmed it was, indeed, a colon met.

That’s just my story. Yours may be different.

Best,
N

[Atoq]

They mean, out of shape and PET results, that is cancer, but if it was a new primary tumor, there are different types of lung cancer and the operation would be more demolitive. It might even require more chemo or radio. I just really wonder how big is the chance that I got a new tumor. Today I did a spirometry test and came out with 137% of forced vital capacity, at least I have some to give away with a surgery

Claudia

[Atoq]

I forgot to write that it was 0.8 cm at diagnosis and now is 1 cm. But is it so easy to detect small differences with CAT scan?

Claudia

[juliej]

I forgot to write that it was 0.8 cm at diagnosis and now is 1 cm. But is it so easy to detect small differences with CAT scan?

Claudia

You're right - that is a very small difference. In fact, that kind of variation can be the difference in the angle of the CT scan that day.

As far as a needle biopsy - that came up with my lung tumors. There were two issues. First, negative results from a needle biopsy aren't considered conclusive. The needle could have selected an area without cancer cells. So a needle biopsy wouldn't have given me a definitive answer.

Second, there is some concern regarding "seeding" from needle biopsies, spreading the cancer cells to new areas. My thoracic surgeon advised using my CEA as an indicator instead, along with changes/growth on the CT scans. My CEA got higher with a metastatic growth and did not rise with a benign growth.

As far as a new primary, it does happen, but it's rare. Most times growths/lesions in CRC patients are CRC-related. However, remember the lungs get lots of growths from other things -- bacterial infections, fungus from gardening/outdoors work, etc. Not everything in your lungs is a lung met. If CEA is good indicator for you (was it elevated at diagnosis?), then your oncologist will probably use it to determine if the growth is likely to be a CRC met. The also might advise a wait-and-watch approach. Or, if it's in a good location, they might just zap it with RFA, ending the problem altogether.

Hope this helps!
Juliej

[CRguy]

To those who had lung metastasis, did you take a needle biopsy before resection to exclude a new primary tumor?
Or given the CRC they were assumed to be metastasis?

Claudia

I did not have a biopsy beforehand.
Biopsies are not 100% all the time, so my surgeon did pathology on the resected section itself and had the whole thing to look at.
My met was on the lobe margin and easily accessible for VATS ... some nodules may not be.

My lung surgeon was a thoracic oncology specialist and when he saw the imaging he said :
" Whatever it is we want it OUT ! "
SO :
I had a wedge resection via VATS ( minimally invasive surgery ) of a single met,
which was confirmed intra-operatively with pathologists standing by to make the diagnosis while I was on the table.

IF it had not been a met, but another primary lung cancer, the surgeon would have done full open chest surgery and lobectomy.
BUTT this was what we discussed beforehand so it was already planned if we had to do that.

This is maybe something to ask your surgeon about as another option ?

Cheers
CRguy

[Atoq]

@Juliej my CEA has always been low in the normal range, so it is not a good indicator for me. They have already scheduled me for a needle biopsy.

@CRguy I asked about doing histology at the same time as surgery but they said that the pathologist needs time to color the sample, I guess they don’t have a routine for that. I only talked to a gastrosurgeon though. But I suspect I will talk to a pneumosurgeon only when the surgery is planned.

Thanks a lot for your help!

Claudia

[Atoq]

They just called me from the hospital, biopsy on Monday.

Claudia

[susie0915]

Well at least after Monday you will know. I have a 4mm nodule that is being watched. Both my oncologist and pulmonologist don't think it's a met but caused by the scarring and inflammation in my lungs. Although my pulmonologist did throw out the possibility of a new lung cancer. Ugh. It hasn't changed since last May so we will keep watching it. It's always on my mind. Good luck Monday.

[Atoq]

Well at least after Monday you will know. I have a 4mm nodule that is being watched. Both my oncologist and pulmonologist don't think it's a met but caused by the scarring and inflammation in my lungs. Although my pulmonologist did throw out the possibility of a new lung cancer. Ugh. It hasn't changed since last May so we will keep watching it. It's always on my mind. Good luck Monday.

Thanks Susie,
The PET scan was positive in my case, so we will see if they manage to sample the right cells. It is good to get it done

Claudia

[Caat55]

Good Morning Claudia,
When you say PET was positive what do you mean?
How is it being back at work?
Susan

[Atoq]

Good Morning Claudia,
When you say PET was positive what do you mean?
How is it being back at work?
Susan

I mean that the SUV in the lung nodule is high, between 5 and 6, which indicates higher metabolism of the cells. I got the report today. Normal values are below 2.5.

It is ok to be back at work, next week I have a lot of teaching and I am also attending a course

Claudia

[Caat55]

Hi Claudia,

Sounds like you should be reading a good book and cuddling the cat! Are you going to get mop up chemo? I know you said they do things differently there than in US. But it seems like this stray cells are what it is aimed at targeting.

Going to take my dog out for a walk between rain and snow storms. The bandages from the port placement are annoying and limit my range of motion in neck, right shoulder, good thing I am a lefty.

Susan

[Atoq]

Hi Claudia,

Sounds like you should be reading a good book and cuddling the cat! Are you going to get mop up chemo? I know you said they do things differently there than in US. But it seems like this stray cells are what it is aimed at targeting.

Going to take my dog out for a walk between rain and snow storms. The bandages from the port placement are annoying and limit my range of motion in neck, right shoulder, good thing I am a lefty.

Susan

I don’t know yet, it depends on the nature of the lung nodule, if it is a metastasis or primary tumor. The board will decide if I need mop up after surgery.

Claudia