hi,they could be inflammatory in origin,consult oncologist

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Brief Answer:
reduced metabolic activity

Detailed Answer:
HI,
Thanks for writing back to me.

I have now, carefully and completely, gone through your entire clinical history by referring all your previously asked queries.

Interval resolution implies reduced metabolic activity of the tracer material uptake (18 FDG),in your lymph node-level 1B-SUBMANDIBULAR group on the left cervical region, as compared to earlier scan reports on PET SCAN. This can be considered a welcome sign usually.

However, in your case the SUV (standardized uptake value) of the tracer is still high 5.4. A value more than 2.5, which is considered threshold for recurrence of cancer process.

The lymph nodal side (note: size greater than 1cm in short axis and greater than 1.5cm in long axis is considered to be malignant)size is only a relative criterion for documenting tumor recurrence.

Hence, even though the lymph nodal size of 13*8 mm is very insignificant, we cannot completely rely on it to feel rest assured.

SUV is the better indicator of tumor recurrence.

Elevated SUV warrants further investigation like lymph nodal biopsy, BONE MARROW examination and peripheral blood counts.

These test results can further help you to confirm the actual ongoing process in your lymph nodes-reactive or relapse.

Further exploration is needed at this hour as NHL -follicular lymphoma is notorious for its recurrences and relapses, which can have atypical presentations at times.

I hope this info is helpful to you,
Post your further queries if any on http://bit.ly/drsureshheijebu.

THANK YOU

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Brief Answer:
Elevated SUV warrants further investigation.

Detailed Answer:
Hi

Yes the suv is still elevated in your case.Higher than the cut off threshold for malignancy/relapse of NHL.

High index of suspicion is needed.

A lymph nodal biopsy of the involved node along with peripheral blood counts can clarify all our doubts.

THANK YOU

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Brief Answer:
Please post SUV of your current pet ct scan

Detailed Answer:
Hi,
Thanks for writing back.

Don't be Confused ,

Please tell me SUV of your current pet ct scan.i need that value.kindly go through your report again and send me the value.

Do not compare interval resolution with SUV,they have interpreted differently and separately .

I would like to clear all your confusion soon.

Awaiting to have the clarified discussion with you.

Thank you

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Brief Answer:
Also post the latest pet scan report, Plus one on 13/3/2013.

Detailed Answer:
Hi,Sir,

I have completely gone through your pet ct scan you posted, dated 12/2/2014.

For detailed comparison i need the most recent pet scan of yours(which showing interval resolution of metabolic activity) as well as the earliest pet scan last year dated 13/2/2013.

Once I receive them i shall give you utmost validated final response on this.

Thank you.

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Brief Answer:
All is well.NO cancer, NO infection.

Detailed Answer:
Hi Sir,
Thanks for furnishing me with the required details of your pet ct scans.

I have carefully read and analysed your reports and would like to draw the following inferences.

1.Your recent most scan at Apollo hospitals revealed interval resolution of metabolic activity(which earlier demonstrated hypermetabolism on pet scan dated 12/4/2014) which indicates zero uptake of any tracer by the lymph nodes of level 1B in the neck.

This means that there is absolutely no evidence of any relapse/recurrence/ new malignant cells in the concerned lymph node.
This is absolutely a welcome sign and a healthy state.

2.Generally presence of infection or new malignant cells in your lymph nodes of neck can lead to increased tracer uptake of glucose by the cells reflecting as hypermetabolism.

So this doubt between infection/inflammation vs relapse/recurrence of cancer in your case was cleared quite cleared pretty easily when your recent pet scan on 6/8/2014 at Apollo hosp showed uptake of FDG tracer by the level 1B lymph node of the neck,suggesting an absolute lack of both infection or relapse cancer .

3.Resolution here implies "disappearance" (of hypermetabolic activity).
Interval here implies period between 12th feb 2014-6th aug 2014.
This period also showed no development of new lesions elsewhere in your whole body as evidenced by the pet scan at Apollo Hosp.

4.The earlier hypermetabolic (pet scan at global hosp)activity is most likely due to some nonspecific infection of your paranasal sinuses which can be quite normal in the general public.This infection was cleared in the subsequent scan.

5.SO AS TO CONCLUDE, YOU CURRENTLY DO NOT HAVE ANY INFLAMMATION OR ANY RELAPSE OF CANCER IN THE LEVEL 1 B LYMPH NODES OF YOUR NECK as evidenced by your pet scan at Apollo hosp dt-6th aug 2014.

6.You have so far had an excellent follow up.I wholeheartedly wish you to maintain the same in the up coming future.

Note:Please carry your old pet scan films and reports along with you when to have your next scheduled pet scan for comparative purposes for the doctors there.

I hope this info is helpful to you.
post your further queries/feedback if any,
Thank you,
Wish you a good health

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Brief Answer:
YOUR APPRECIATION RECEIVED.

Detailed Answer:
Hello sir,
Thanks for your appreciation.
My best wishes to you.
take care

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