Reading the CT scans after the laser assisted surgery

[Olga]

Some people expressed to me their concerns regarding the possible difficulties for the radiologist reading the CT scans after the laser assisted surgery and I explained to them all I know about in my best knowledge - other patient are welcome to add their comment.
There are specific difficulties in interpreting of the CT scan after the laser assisted surgery (or RFA or cryo for the smaller nodules also).
With the laser assisted surgery some of the nodules that are not resected but rather burned on the spot - the ones that are less then 2-3 mm and Dr.Rolle does not usually take them out to save more lung tissue, they are just left to dissolve as the time goes - they are round necrotic tissue nodules that for the radiologist are not distinguishable from the real sarcoma nodules and they are bigger then the initial ones by 2-3 mm so the radiologist might report them a growth. Also there will be a lot of the nodules that were not seen on the scan before - smaller then 1-2 mm - and they became seen after Dr.Rolle burned them so they might report them as a new ones. These necrotic nodules stay on the scans for awhile and then they start to contract into the line but not always depends on the location probably or I do not know what else, but some of them are still round for years. On the last surgery a few of the about 5 mm nodules Ivan had were round necrotic tissue and actually no one knows what it was after the previous surgery on that lung being done 3.5 years ago they might be remaining of the ablated nodules or some signs of the immune competency when some nodules were killed by the immune system or some signs of the metastatic growth insufficiency when then lucked something to grow and died instead. So the general rule for the after laser assisted surgery reading is this - first scan is done as a base line bearing in mind all of the above. Then the consecutive scans are done with the longer interval in between may be 4-5 month to see a new growth. If they grow they new/missed on the surgery (that happens at times when there are many nodules and the lung gets stiffer as the time goes so they are not palpable toward the end of the surgery), when they grow up to 10 mm they need to be ablated RFA or cryo/removed by the next surgery. If they are stable they probably necrotic but they need to be watched. If they are stable for a year they are most probably necrotic. It is not necessary to send to Dr.Rolle the very first after surgery scan as it is usually the less informative one (unless something emergency will be found) but it might be good to send the second one with the first one on the same disk.
You might want to make sure that the radiologist is aware about the nature of the laser assisted surgery, when you go for the scan bring something with you (the copy of the surgical report or a printout of an article about the laser assisted surgery) and give it to them, it helps.