Discussion of interesting or befuddling cases related to pulmonary and critical care medicine.
Monday, May 12, 2008
stage iiia?
Would this PET scan be enough to convince you that this is IIIa or would you have the surgeon go after that node for staging purposes? A corollary: if that node is negative, would he be a surgical candidate (assuming lung function etc. not issue)
I have seen WAY too many people incorrectly denied surgery because of a PET scan. Then done an EBUS on the node only to find granulomas, so my opinion is colored by that experience. The utility of the PET should be to tell you WHAT to biopsy, rather than NOT to biopsy. Just my not so humble opinion. If this was my patient I'd expect the surgeons to get the node if the patient was otherwise a surgical candidate.
Some surgeons might balk at this because it would require a chamberlain procedure (or some might drop in a t-scope) to get the pre-aortic node, but it makes more sense to do that if the patient is otherwise robust. I suspect at a place like HFHS the surgeons would (appropriately) be aggressive about a situation like this. It is a matter of giving the patient the benefit of the doubt.
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I have seen WAY too many people incorrectly denied surgery because of a PET scan. Then done an EBUS on the node only to find granulomas, so my opinion is colored by that experience. The utility of the PET should be to tell you WHAT to biopsy, rather than NOT to biopsy. Just my not so humble opinion. If this was my patient I'd expect the surgeons to get the node if the patient was otherwise a surgical candidate.
Ok thanks I wasn't sure either (about assuming IIIa just based on pet). I'll send him for node sampling (he is otherwise a surgical candidate).
Some surgeons might balk at this because it would require a chamberlain procedure (or some might drop in a t-scope) to get the pre-aortic node, but it makes more sense to do that if the patient is otherwise robust. I suspect at a place like HFHS the surgeons would (appropriately) be aggressive about a situation like this. It is a matter of giving the patient the benefit of the doubt.
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