We have a saying 'All that glitters is not gold .' This is so true in medicine and also in amny other aspects of life . Many a times we come across people that we think are OK or honest or good and then our experience tells us otherwise . But in medicine we depend upon many tests and then newer tests ae suppose to be 'better' than our own judgements or intuition. So we make decision based on theses tests and most of the times they are accurate and sometimes not so . In medicine we talk about sensitivity and specificity of a test . These words mean what is the chance of Picking up disease when positive and missing when negative and also How specific they are when they are positive. So a test could be positive highly sensitive , but may not be specific . As the time goes on and we have more and more experience and data , we know the values and make out decisions based on that . That brings me to the story for today.
I had seen this patient many years ago and then she had allergies and asthma and she was treated and did good . She saw allergist and then was started on allergy shots and so she stopped coming to me . She then was admitted to hospital with shortness of breath and she had CT scan done and a clot in her lungs was diagnosed . She had a history of a clot in lungs in past and so now she has be on blood thinner - anticoagulation for life long . But when we had done CT scan ,she also had a nodule. A nodule is density less than 2.5 cm , We call density a mass , when it is larger than 2.5 cm or an inch. I did the work up .As she had recent clot, we did not do any biopsy. I did do breathing test to assess her lung capacity and then also did PET SCAN . As I have mentioned in my previous blogs , the PET SCAN picks up glucose activity - metabolism in cells and so when higher concentration of glucose is picked up the likelihood of cancer is higher .So we did PET scan and she had high pick up in the nodule. So, I sent her to a chest surgeon. He saw her and was not too sure or I am not sure , but did not do surgery. She came back to me and was quite concerned as to the possibility of cancer was raised and she had family history of lung cancer and she was worried that if we leave the cancer for longer time , then it may spread and then surgery will be mute . I saw her again and was not sure . So I called the surgeon. He wanted to do new scans and then decide .I told him the concern of the patient and also my concern as the PET scan was positive and suggestive of cancer.
He saw her in office and then she had surgery done. The lymph nodes were negative of cancer and the Majority of the nodule was scar and inflammation. There was a 1 mm portion that was abnormal called CARCINOID. The carcinoid is considered as either a benign tumor which very rarely can spread or malignant tumor which very rarely spread . Si I don't think she had cancer but the PET scan was positive !! and we based our decision on the test !!
