PET report:
Findings:
Low-grade uptake associated with mucosal thickening in the right maxillary sinus and nasal passages bilaterally is in keeping with inflammation. There is prominent but symmetric uptake in the tonsils bilaterally which is likely physiologic or inflammatory in nature.
No lymphadenopathy by size or metabolic criteria identified in the head and neck, supraclavicular, axillary or inguinal regions.
The diffusely increased lung activity seen on the previous PET/CT has been resolved as have areas of hypermetabolic air space opacification in the posterior aspect of the right lower lobe. These findings are in keeping with resolution of an inflammatory process. No new nodules including a stable-appearing 5-mm subpleural nodule in the anterior aspect of the right upper lobe and an 8x5mm nodule in the right middle lobe which remained non-FDG avid. No increased uptake seen within hilar lymph nodes. The residual 4.3x2cm nodal mass in the right anterior mediastinum is non-FDG avid. No new hypermetabolic lymph nodes re identified in the hilar, mediastinal or retrocrural regions.
No FDG-avid lesions are identified in the liver or spleen. The spleen measures 12.5cm in greatest transverse dimension. No increased uptake is seen within upper abdominal, mesenteric or retroperitoneal lymph nodes. No focal bowel lesions are identified.
No FDG avid or destructive bone lesions were seen.
Note is made of a right-sided central venous access device with its tip in the right atrium.
Impression:
No evidence of FDG-avid lymphoma. Findings in the right maxillary sinus and nasal passages are in keeping with mild inflammation.
On the lymphoid cancer PET scan grading scale this study is considered grade 2.
Lymphoid Cancer PET Scan Grading Scale:
1- Negative scan, no evidence of active lymphoma
2- Positive scan, unlikely related to lymphoma
3- Indeterminate
4- Positive scan, possible related to active lymphoma
5- Positive scan, likely related to lymphoma
Post treatment monitoring will be bloodwork every 3 months for a year and a CT scan in 6 months. Typically a CT scan is not done in British Columbia as a standard for post treatment monitoring but Doc Restrepo wanted to have one done to ensure the inflammation observed on the PET scan has resolved and that the nodules in the lung (which are likely scar tissue) have not increased in size.
The relapse rate for late stage classic Hodgkins Lymphoma is approximately 30% with the overwhelming majority happening in the first year.
