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Lung Cancer

Latest interval CT

04/09/2009

Question:

Since 1999, I have participated in the I-ELCap program because of several risk factors including 20 pack years,strong family history for lung cancer and age (I was 42 when I began participating). Radiologists at Cornell found "at least six nodules less than 5mm scattered bilaterally." Fortunately, all have remained stable.

After years of running to NYC, I decided to have the screens done at Holy Cross Hospital in Maryland, another I-ELCap site. For the past two years, HC radiologists have detected fewer nodules, with a greater specificity than the Cornell reports. I was surprised and last year asked radiologists in NYC for a second read and their conclusion was the same as it`s always been.

I guess I have two questions -- can there be different interpretations by two different radiologists?

The second question has to do with one of the nodules itself. It`s approximately 5 X 3 mm in the right apical portion of the lung where there is scarring. The HC report indicates that while it was stable, it also was part solid and had irregular borders.

Can a nodule in scarred lung tissue look like that? Again, the radiologists at Cornell (who developed the protocol) have seen it but don`t characterize it either way. (Also, the nodules detected HC radiologists last year are a shade smaller in size and further away from the pleural boundary.)

Sorry for the lengthy question.

Answer:

Thank you for your question. The answer to your first question is that yes, there can be variation in radiologist readings particularly in the cases of indeterminate nodules. In addition, nodules of this size may be inflammatory and self resolve. In terms of your second question, this also speaks to variability in radiologist readings. Nodules in scarred areas of the lung can have various appearances. The fact that the nodules are being closely followed and have remained stable should be very reassuring.

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Response by:

Patrick  Nana-Sinkam, MD Patrick Nana-Sinkam, MD
Associate Professor of Pulmonary, Allergy, Critical Care & Sleep
College of Medicine
The Ohio State University