“We need to be enormously careful about this,” he said, cautioning that an overenthusiastic reading of tiny, likely benign nodules could serve to up-stage a patient, with significant treatment implications. “You can't write the patient off, because we do see small nodules,” he said.
Dr. Patz recalled a mentor once telling him, “A radiologist with a ruler is a radiologist in trouble.” He urged colleagues to be circumspect in writing their reports, and simply characterize what they see rather than make inferences about the malignant potential of the small lesions on a scan.
He also warned that current imaging modalities are not uniformly accurate when it comes to lymph nodes and nodal groups. CT scans are about 60% sensitive and specific in identifying involved nodes; PET scans increase the accuracy to about 80%.
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New subcategories of stage T1 disease based on tumor size have been created in an effort to more accurately assess an individual patient's prognosis.
Source COURTESY INTERNATIONAL ASSOCIATION FOR THE STUDY OF LUNG CANCER (IASLC). COPYRIGHT 2008 ALETTA ANN FRAZIER, M.D.