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Dr. David
Dr. David, Doctor (MD)
Category: Oncology
Satisfied Customers: 46271
Experience:  Experienced Oncology Physician trained in New York City. I'm ready to help.
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.: Husband had a good question - which I 't think I

Customer Question

For Dr. David: Husband had a good question - which I don't think I thought to ask: I know you've said that it's now how they normally present, but have you ever personally seen breast mets to the lungs on a CT scan that were speculated/ground glass (either or both)?

Submitted: 2 years ago.
Category: Oncology
Expert:  Dr. David replied 2 years ago.
Hello, this is Dr. David. I have read your question and I'm ready to help.

I have seen mets to the lungs be spiculated

but not ground glass.
Customer: replied 2 years ago.

But haven't you said repeatedly that mets to the lungs don't appear as ground glass or spiculated, and that you'd bet that neither represents mets? If you've seen mets that were spiculated, why have you said it's highly unlikely in this case?

Expert:  Dr. David replied 2 years ago.
no, I said they don't look like ground glass

they can be spiculated.

most mets are smooth round balls in the lungs

primary lung cancers can be spiculated.

mets in some cases can be spiculated.

mets are highly unlikely to be both spiculated and ground glass.
Customer: replied 2 years ago.

Now I'm not only confused - but terrified. I posted the description of these lesions from my first question, and it describes two ground glass and one small spiculated lesion:

Current study demonstrates interval development of several right-sided pulmonary lesions since study from 2014. Focal area
of mixed solid/groundglass opacity in the right anterior lung measuring approximately 14 x 24 mm series 3 image 57 is new since prior study.Along the superior aspect of this lesion there is a smaller ground glass opacity measuring approximately 6 mm series 3 image 54 that is new since prior study as well.

Additional spiculated lesion in right lung anteriorly measures
approximately 17 x 12 mm series 3 image 79 also appears new.

You have consistently said this is not how mets appears, and that you would bet it's not mets. If you're now saying that the speculated lesion could be mets, that represents an entirely different opinion.

Expert:  Dr. David replied 2 years ago.
it doesn't sound like these question and answer sessions are really helping to decrease your anxiety

there is only so much we can do with just talking about descriptions of CT scans which I can't see

I am trying to help you out as best as I can.

but nothing in medicine is 100%

and speculating at your findings for weeks and weeks until you get a repeated CT scan is not really helping you

it sounds like you are looking for certainty in an uncertain world.

and there is no certainty in these descriptions of your lung findings.

I said before that lung mets can in rare cases be lung metastasis.

I doubt that they are in your situation.

but I can't see your scan images.
Customer: replied 2 years ago.

This is about clarity more than anxiety. To be fair, the question I've asked repeatedly included both ground glass and a spiculated lesion - and I made a point of asking several times if either ground glass or speculated was what you'd see with mets. I included the actual description of the lesions from the report in the first question, and we referred to that description throughout. Looking at the description of the lesions again, are you now saying that the speculated lesion is consistent with mets?

Expert:  Dr. David replied 2 years ago.
no, I never said they were consistent with mets

I said that in some cases, mets can look like spiculated lung lesions.

and it would be very very unlikely for ground glass lesions to be lung mets.
Customer: replied 1 year ago.

So - when you repeatedly said mets don't look like this - and I bet this isn't mets, had you read and understood that the report I cut/pasted into the question describes a speculated lesion - which we referred to throughout several subsequent questions? If not, does this now make it more likely that this could be mets from the breast?

At several points, I asked again about the spiculated lesion versus ground glass:

Q. What about the spiculated lesion? Is that consistent with breast cancer?

A. no, it is ground glass as well

Q.I apologize Dr. D. - but I'm not sure I understand what 'no, it is ground glass as well" is in response to. I tried to space my questions out to try to avoid confusion on my part, but I guess I didn't do it too well!

A. you asked me about that 6mm spiculated lesion which was ground glass as well.

Q.I thought that many ground glass lesions are cancerous, and over 90% of spiculated lesions/nodules are cancerous in the lungs, which would hardly be considered rare. Is that wrong?

Are all spiculated lesions also ground glass? Are you as confident about the spiculated lesion not being mets as you are about the other ground glass lesions?

A.I am a cancer doctor.

I don't see mets in the lungs look like this.

mets in the lung look like solid round smooth multiple lesions in the lung field.

Is this accurate?

Expert:  Dr. David replied 1 year ago.
I have never seen spiculated ground glass lesions in the lungs as lung mets.

ground glass makes it less likely to be mets in my opinion.

90% of spiculated lung lesions are not cancer in the lungs.

not all spiculated are ground glass.

they are two different descriptions
Customer: replied 1 year ago.

So - when you've said all along that the description of my lesions doesn't sound like mets, you fully understood that one of the lesions is speculated but there's no mention (that I can see) of it being ground glass?

The reason I'm confused is that you have been so adamant that this isn't what you see with mets, yet it now sounds like you're saying that you do see speculated lesions with mets, and we now the report says there is one (which is what they would biopsy if it doesn't decrease in size over the next few weeks).

Just as an aside, my husband thinks the oncologist may have said he can see through that lesion (I think he described it as more of an area shaped like a triangle), which may mean it's ground glass - or at least not solid??

Expert:  Dr. David replied 1 year ago.
could be ground glass or not solid.

too much speculation

I need to see the images.
Customer: replied 1 year ago.

Not really speculation at this point, but more clarification. Did you understand that one of the lesions is spiculated with no mention of it being ground glass when you said it's not consistent with mets? Is your assessment the same?

Do reports usually indicate if a spiculated lesion or area is ground glass or solid? If so, is it odd that this report offers no other details other than it's spiculated, it's size, and where it's located? Is there some assumption that spiculated is one or the other, unless otherwise noted?

Expert:  Dr. David replied 1 year ago.
I though they were all ground glass

I need to look at the scan.

reports can vary. radiology doctors are not all the same. they are not all as careful with description of lesions as you are with your words
Customer: replied 1 year ago.

Now perhaps you can understand why I repeatedly asked for clarity, and I did ask repeatedly if you were including the spiculated lesion in your assessment. I'm not sure how that point could have been missed. Are you now saying that it sounds more like it could be mets?

Obviously I'm concerned and frustrated because I was clear it my questions and had provided the actual language from the report. While I understand that seeing the images would be ideal (I don't have them), I was really only asking your opinion based on the assumption that the radiologist's report described the lesions accurately. If not knowing whether the spiculated lesion is solid or not changes your assessment, I'd rather know.

Also, when you say that 90% of spiculated lesions in the lungs are benign, is that unique to the lungs? From the information I've been able to find online, it sounds like speculated lesions are 90% likely to BE cancer. Is that only the case in other areas of the body - but doesn't apply to the lungs?

Expert:  Dr. David replied 1 year ago.
pneumonia can cause spiculated lesions in the lung

pneumonia is very common and more common than cancer in the lungs

radiologist are worried about spiculated lesions, because they don't want to miss one lung cancer.

without looking the scans, I can't give you more reassurance.

I have told you that I am not worried about breast cancer being metastatic in your lungs at this point based on your case history.

you have recently gotten over lung infection.

you recently had breast radiation therapy.

so your case is not routine

we don't look at the lung lesions in isolation, but with the patient in total

that is how your doctors are looking at your case

and they don't seem worried enough at this point to do a lung biopsy.

they are betting that your lungs will clear up in a few weeks

that means they think your lung lesions are benign.
Customer: replied 1 year ago.

I agree with you that my history (and the fact that this breast cancer was not diagnosed when it should have been) probably effects how this is being characterized to a point, but I actually think they do feel there's a reasonable chance its mets, but are willing to wait a few weeks in case it's post infection, maybe just to appease me - it's hard to know. I think they are worried.

But since you're disconnected from this, you can be objective. I know that you've told me all along that you're not worried about mets, but you have also said that you misunderstood and thought the spiculated lesion was ground glass. The report doesn't say anything else about the spiculated lesion, other than its size and location. Knowing this, do you now feel it's not as unlikely to be mets as you originally thought? Do reports usually mention if each lesion is solid, ground glass, etc.? If so, is it possible because they've noted the other two are GG's, they're inferring that the third is the same?

Did you mean to say that spiculated lesions are 90% benign in the lungs - and if so, is that unique to the lungs? Most resources indicate that speculated lesions are far more likely to be cancerous. Is that refrying to other areas of the body, excluding lungs?

Expert:  Dr. David replied 1 year ago.
I told you already it is about 50/50 chance benign or malignant.

that is what I have said to you before.

you can't read into the radiology report.

I can't read their minds.
Customer: replied 1 year ago.

Sorry again to be persistent, but when you originally said 50/50, you're now saying that you mistakenly thought the spiculated lesion was ground glass, but now we don't know. Not knowing if it's GG doesn't change you opinion?

Can you clarify your comment that 90% of spiculated lesions in the lung are benign? Is that accurate? Does that only apply to the lungs, since spiculation is generally referred to as being highly suspicious for cancer? If so, can you point me towards any reference to this, or is it just based on your own experience?

Expert:  Dr. David replied 1 year ago.

if you consider all of the spiculated lesions which are from scar tissue or pneumonia, many of them are benign.

this is based on my own experience.