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PET scan shows fissure in lobe. Have chronic cough and breathlessness. Chances of biopsy?

Hello, I am a 37 year old female, recently diagnosed with suspected renal cell carcinoma . It is stage 1, and the tumor is 2,3 cm. I had a PET scan last week because of a chronic cough and very mild shortness of breath, and a 4 mm nodule was detected adjacent to the major fissure within the right lower lobe . The report says Displays no abnormal FDG uptake but might be too small to be accurately characterized by PET. This is felt to probably represent a small area of atelectasis or scarring . The final summary says it is suspicious for metastatic disease. I will be seeing a pulmonologist soon, and am wondering what the chances are that he will want to do a biopsy, given my RCC? My urologist doesn t seem too concerned, but as a mother of 2 very young girls, I am very concerned. With RCC stage 1, what are the chances that this is metastatic disease? I also have a reactive lymph node within the right hilum. What does that mean? Thank you so much! --Linda
Asked On : Wed, 21 Nov 2012
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  User's Response

Sorry to hear about your Renal mass.

Let us discuss about your query on the lung lesion. You do mention that you have a history of chronic cough. For a 4 mm nodule, there is no imaging that could tell you if it is metastatic or not. The only way would be to take it off. But again for a 4mm nodule, doing an additional lung procedure would add to your hospital stay and expenses. The history of chronic cough again adds to the odds that it is not a metastatic lesion. Though I am not able to provide you an exact figure, the incidence of metastases in a 3cm T1 lesion is low.

I would concur with your surgeon. Currently concentrate on the renal mass and its treatment. You could get a repeat CT examination in 3-6 months time to monitor the lung nodule. If the nodule stays the same size then it is reassuring.

The reactive node means that it is draining some area of infection and hence enlarged - a finding again in favour of the lung nodule being infective.

Close follow up is the best option that I see in your case.

Hope it helped you.

Regards and Best wishes.
Answered: Sat, 16 Feb 2013
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