No “definite” evidence of metabolically active disease

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Static500
Posts: 10
Joined: Tue Jan 12, 2021 6:48 pm

No “definite” evidence of metabolically active disease

Postby Static500 » Thu Aug 05, 2021 9:18 pm

Hi,

Regarding the interpretation/summary section of a PETCT scan report, is there a difference between No Evidence of Disease and No ‘Definite’ Evidence of Disease? Am guessing it’s just an alternative way of the report writer confirming NED - as opposed to being because there are some question marks over the findings - but this is the only scan I’ve ever had that also has the word ‘definite’. (The main body of the report is pretty sparse just saying no focal pathological uptake or tracer uptake unremarkable so can’t see anything left open to question or indeterminate. Was in relation to some thickening that developed near anastomosis site since Easter following right hemi last year.)

Thanks.
41m, stage IIIb
BRAF V600E mutation

10/20 dx stage IIIb colon cancer after severe anaemia (shortness of breath when running)
T3/4 N1 M0 R0 L1 V1
ascending colon tumour 65mm, poorly differentiated
Lymphatic and venous invasion
2 of 28 lymph nodes positive
Various polyps incl one with low grade dysplasia (to be removed via polypectomy post chemo)

10/20 laparoscopic right-sided hemicolectomy with clear margins

12/20 - 2/21 3m CAPOX

2/21, 6/21 scans NED

Rock_Robster
Posts: 1027
Joined: Thu Oct 25, 2018 5:27 am
Location: Brisbane, Australia

Re: No “definite” evidence of metabolically active disease

Postby Rock_Robster » Fri Aug 06, 2021 3:33 am

Of course we can’t put ourselves in the mind of the radiologist to know for sure, but my read of this would be that while there may have been some features which are ambiguous or uncertain (although as you indicate, there was nothing specified in the report) or they may be limited in what they can see/assess from the scan - they do not lead the radiologist to confidently conclude that there is metabolic disease present (which is a good thing, of course!).

Did they recommend any further scans or investigations? Often if they aren’t confident they will do this as part of their findings. It would also be helpful to get your oncologist’s (or surgeon’s) interpretation of this to guide you.

Best of luck,
Rob
41M Australia
2018 Dx RC
G2 EMVI LVI, 4 liver mets
pT3N1aM1a Stage IVa MSS NRAS G13R
CEA 14>2>32>16>19>30>140>70
11/18 FOLFOX
3/19 Liver resection
5/19 Pelvic IMRT
7/19 ULAR
8/19 Liver met
8/19 FOLFOX, FOLFOXIRI, FOLFIRI
12/19 Liver resection
NED 2 years
11/21 Liver met, PALN, lung nodules
3/22 PVE, lymphadenectomy, liver SBRT
10/22 PALN SBRT
11/22 Liver mets, peri nodule. Xeloda+Bev
4/23 XELIRI+Bev
9/23 ATRIUM trial
12/23 Modified FOLFIRI+Bev
3/24 VAXINIA (CF33 + hNIS) trial

Static500
Posts: 10
Joined: Tue Jan 12, 2021 6:48 pm

Re: No “definite” evidence of metabolically active disease

Postby Static500 » Fri Aug 06, 2021 5:42 pm

Thanks for your reply, Rob. Yes, similar to my reading but then if there was anything potentially ambiguous or uncertain I was anticipating it would have been mentioned in the main body of the report, e.g. ‘slightly elevated tracer uptake at xxxx’ etc. Hence why I was thinking the additional word ‘definite’ might not have any significance compared to the usual NED line in my other reports.

Next scan is in 4 months rather than 6 but maybe to align it with 1 year since surgery. Only spoke to member of oncology team rather than oncologist who did not provide any detail on the report (did not receive it until after the appointment) and just said result was clear scan and that unsure what the thickening near anastomosis site is. Given the thickening is detectable on a CT then I would have thought it would light up on a PET scan if it was cancerous (and my tumour was not mucinous which I know can limit detection in some cases). From what I understand, fibrosis / scar tissue formation can happen for quite a while post op so this strikes me as the most likely explanation (the thickening was very faintly visible on my Feb CT scan and had developed further on the June scan).
41m, stage IIIb
BRAF V600E mutation

10/20 dx stage IIIb colon cancer after severe anaemia (shortness of breath when running)
T3/4 N1 M0 R0 L1 V1
ascending colon tumour 65mm, poorly differentiated
Lymphatic and venous invasion
2 of 28 lymph nodes positive
Various polyps incl one with low grade dysplasia (to be removed via polypectomy post chemo)

10/20 laparoscopic right-sided hemicolectomy with clear margins

12/20 - 2/21 3m CAPOX

2/21, 6/21 scans NED

Rock_Robster
Posts: 1027
Joined: Thu Oct 25, 2018 5:27 am
Location: Brisbane, Australia

Re: No “definite” evidence of metabolically active disease

Postby Rock_Robster » Fri Aug 06, 2021 9:34 pm

Static500 wrote:Thanks for your reply, Rob. Yes, similar to my reading but then if there was anything potentially ambiguous or uncertain I was anticipating it would have been mentioned in the main body of the report, e.g. ‘slightly elevated tracer uptake at xxxx’ etc. Hence why I was thinking the additional word ‘definite’ might not have any significance compared to the usual NED line in my other reports.

Next scan is in 4 months rather than 6 but maybe to align it with 1 year since surgery. Only spoke to member of oncology team rather than oncologist who did not provide any detail on the report (did not receive it until after the appointment) and just said result was clear scan and that unsure what the thickening near anastomosis site is. Given the thickening is detectable on a CT then I would have thought it would light up on a PET scan if it was cancerous (and my tumour was not mucinous which I know can limit detection in some cases). From what I understand, fibrosis / scar tissue formation can happen for quite a while post op so this strikes me as the most likely explanation (the thickening was very faintly visible on my Feb CT scan and had developed further on the June scan).

Sounds logical to me. And indeed post-op thickening is certainly not uncommon. I guess it’s just a risk/benefit trade-off assessment, which is where I usually take a lot of steer from my oncologist when making.

When’s your next scope? As you clearly know it can be challenging to image the bowel well with any medium really, so if there were concerns about the anastomosis site then a camera is probably the best way to be sure. If there was any doubt they can always grab a few cells to stick under a microscope too.
41M Australia
2018 Dx RC
G2 EMVI LVI, 4 liver mets
pT3N1aM1a Stage IVa MSS NRAS G13R
CEA 14>2>32>16>19>30>140>70
11/18 FOLFOX
3/19 Liver resection
5/19 Pelvic IMRT
7/19 ULAR
8/19 Liver met
8/19 FOLFOX, FOLFOXIRI, FOLFIRI
12/19 Liver resection
NED 2 years
11/21 Liver met, PALN, lung nodules
3/22 PVE, lymphadenectomy, liver SBRT
10/22 PALN SBRT
11/22 Liver mets, peri nodule. Xeloda+Bev
4/23 XELIRI+Bev
9/23 ATRIUM trial
12/23 Modified FOLFIRI+Bev
3/24 VAXINIA (CF33 + hNIS) trial

Static500
Posts: 10
Joined: Tue Jan 12, 2021 6:48 pm

Re: No “definite” evidence of metabolically active disease

Postby Static500 » Fri Aug 06, 2021 9:52 pm

Actually had first scope post op in late April which was clean (so next one in 12m). However, I am unsure whether a colonoscopy would actually be able to view this thickening as from what I understand it is in right iliac fossa region near to anastomosis site as opposed to within the colon itself if that makes sense.
41m, stage IIIb
BRAF V600E mutation

10/20 dx stage IIIb colon cancer after severe anaemia (shortness of breath when running)
T3/4 N1 M0 R0 L1 V1
ascending colon tumour 65mm, poorly differentiated
Lymphatic and venous invasion
2 of 28 lymph nodes positive
Various polyps incl one with low grade dysplasia (to be removed via polypectomy post chemo)

10/20 laparoscopic right-sided hemicolectomy with clear margins

12/20 - 2/21 3m CAPOX

2/21, 6/21 scans NED


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