0:00

In this case, we have a 63-year-old female

0:02

with a 40 pack year history of smoking

0:05

who is actively smoking at the time

0:07

of undergoing lung cancer screening ct.

0:09

Well, let's take a look.

0:11

We have a small apical blob in the right lung surface there,

0:15

a simple benign finding.

0:16

And ooh, immediately we see a

0:18

irregular spiculated nodule.

0:21

We see these speculations extending to the pleural surface,

0:25

which means it at least is in contact

0:27

with the visceral pleura.

0:28

We can't tell if it's invaded

0:29

through the visceral into the parietal pleura.

0:32

On imaging.

0:34

One of the limited abilities that we have

0:37

with chest CT is invasion.

0:40

Unless it's outright into the chest wall

0:42

or there's rib destruction, it can be very hard for us

0:45

to identify a pleural invasion,

0:48

but clearly a spiculated nodule that's measured 17

0:52

by 25 millimeters.

0:55

And let's not pay all of our attention there

0:57

and forget to look at the rest

0:59

of the lung parenchyma in detail.

1:00

So we continue to scroll through the lungs looking

1:02

for lung disease and looking for other pulmonary nodules.

1:08

And as we scroll down the lung, we find a second nodule.

1:12

So here we have a smoothly marginated 10

1:15

by five millimeter nodule.

1:16

We can put our cursors on

1:18

and measure the minimum max in diameter.

1:21

If we look at the diameter of the first nodule

1:25

that we found from our AI output, we can see

1:28

that it's drawn reasonable contours to the margins of it.

1:31

It measures it at an average diameter 20.9

1:34

or 21 millimeters, and it measures all of the diameters.

1:39

It measures the minimum diameter at 17 in the maximum

1:41

diameter of 24.6, so a 17

1:44

by 25 millimeter speculated right upper lobe nodule.

1:48

This would be a lung RADS four B on a baseline lung

1:51

cancer screening ct.

1:53

And then of course we have the second nodule in the middle

1:56

lobe, which could be a second primary neoplasm.

2:00

So what was next done with the high risk

2:02

of cancer is a pet ct, both to characterize the nodule

2:05

as well as to look for any potential evidence

2:07

of tumor spread.

2:09

So in the chest, the PET CT

2:11

for pulmonary nodules both serves to characterize the nodule

2:15

as you can see it here, intense FDG uptake.

2:18

So this, uh, reaffirms the high risk of lung cancer not only

2:21

by the imaging size and morphology as well as its uptake,

2:25

but it's also a staging test at the same time.

2:27

So both diagnosis, looking for uptake in the nodule

2:30

as well as staging.

2:31

So we're gonna look for any lymph nodes in the mediastinum,

2:35

any uptake in the solid abdominal organs like the liver

2:38

and adrenal glands that lung cancer is prone to go

2:40

to as well as the bones.

2:43

So dual purpose exam for purposes of chest imaging

2:46

and lung nodule evaluation.

2:48

So we have high risk lesion by lung rats.

2:50

Four B high risk lesion by

2:53

morphology and uptake.

2:55

And then let's look at where that second nodule was.

2:59

Does that have any uptake on the PET ct?

3:01

We're gonna use our anatomic correlation to our ct,

3:04

which is gonna be a higher resolution image than the CT

3:08

images used for attenuation correction on the PET ct.

3:12

And there's no uptake in that middle lobe nodule.

3:15

So given its size 10 by five millimeters,

3:18

you'd expect a cancer of that size to take up radiotracer.

3:22

But we know that this patient almost certainly has lung

3:25

cancer in the upper lobe.

3:27

So the decision this patient was to take them

3:30

for a thoracoscopic right upper lobectomy, which confirmed

3:33

that this tumor in the right upper lobe, it was an invasive,

3:36

moderately differentiated non keratinizing squamous cell

3:40

carcinoma following the lobectomy

3:42

and middle of what resection.

3:44

Uh, the patient has been followed subsequently

3:46

with annual surveillance, uh, CT exams

3:49

for their known diagnosis of lung cancer

3:51

and has had no evidence recurrence

3:53

to years following surgical resection.