We have great progress in medicine in last few years - as I can say 'in front of my eyes.' We did not have pet scan 40 years ago and CT scan was easily available for us in medicine for only 40 years. But sometimes the new tests add to answers and help in making decisions in maedicine and sometimes it add to more questions. We started about what was then called as Liquid Biopsy few years ago and that was trying to detect TUMOR DNA in blood or urine and that would help to detect cancer at earlier stage - in hope that it was 'curable'. We also have some newer tests called NODIFY2 where detecting certain protein would help us to calculate probability of cancer . So we can do calculation without the tests and then redo it after the blood tests are done and see if the probability is 'increased' or 'decreased'. But still that did not give us the diagnosis. This brings me to case for today.
I saw this patient in office may be 67 years old , She had routine ? CT scan . So few years ago the Medicare approved doing CT scan of the chest to detect Lung Cancer at earlier age without having abnormal chest x- ray in certain group of patients. The smokers and nonsmoker for 14 years are included. So this patient was having CT scan done - which is called LOW DOSE RADIATION SCREEING CT SCAN OF CHEST . (There is a special code for doing this tests) So when she had CT scan in 2018 there was no abnormality . She continued to have new scan yearly except in 2020. Due to COVID in 2020 she did not have the scan . She has no major symptoms like cough , fever or chest pain or shortness of the breath. So she had new scan in 2022 and when that was compared to one done in 2021 ,she had new nodule ,size of 9 mm . For some 15 mm make an inch . So it is very small but not of that size that we can just do follow up as that could be due section variations . (The sectioning variation may be due to size of cuts in CT scan ) She came to me . I saw the CT scan and decided to do the test called PET scan . In PETS scan one is injected with glucose and that is picked up by ALL the cells in body and then a scan is done and where ever the glucose concentration is high compared to normal cells in that organs will indicate cancer or infection or inflammation.. The cut of for doing this test is 8 mm as the nodules bellow that size may not have enough cells to 'show up ' on the scan . So she had borderline size for PET SCAN and i did that and the activity came as 'borderline . I have also ordered blood tests called NODIFY2 which is good for nodules with size of 8 mm minimal. Again borderline size . I don't have the report yet . But now I have a patient who has 9 mm NEW nodule and the PET scan is borderline pick up. The size is not large to do needle biopsy, and now we have to make a decision as to what to do. We can do open biopsy and take out 1/3 of lung and get diagnosis. Or we can do follow up CT scan in near future - may be in 3 months .So the new tests have not added much to help us change the course of our action is diagnosing the cancer. If I did not have PET SCAN ,I would have done the follow up on scan only . So by doing the PET SCAN i now have more question as the metabolic activity was not 0 but was lower level where I HAVE TO MAKE A JUDGEMENT CALL !!
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