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What Test Should Be Done To Check If A Finding Is Benign Or Malignant?
Question: Good-afternoon,
I have a question(s) related to a CT Scan of my abdomen. Here is a brief timeline:
November 2017 - Seen for abdominal pain, nausea, and acid reflux with chest pain (still ongoing).
December 2017 - Endoscopy (normal)
January 2018 - CT Scan
CT Scan Findings:
Best demonstrated on the axial and coronal reconstruction (axial image 40, coronal image 47) is a 1 cm rounded soft tissue density at the junction of the second and third portion of the duodenum near the expected location of the ampulla.
Impression:
1. Negative for bowel obstruction, focal inflammation or fluid collection.
2. Possible small 1 cm polyp or mural nodule at the junction of the second and third portions of the duodenum near the expected location of the ampulla.
My GI doctor said not to worry and follow up in 3 - 6 months. I have followed up at 6 mos and he told me this was "high risk" and I needed an endoscopy. The diagnosis he listed was, "benign adenomatous neoplasm." I am shocked that it sounds more serious now than when my CT scan results were initially presented.
Questions:
1. Does the CT Scan findings/impression indicate something benign? I cannot imagine how he would know it's benign from the CT Scan alone. He does not seem worried about this aspect, but I am about malignancy.
2. How serious is this if it is benign? He seemed more worried about it being a "high risk removal.
3. Should I have another CT Scan since it's been six months? I feel that is a long time.
I really appreciate your help on this worry.
I have a question(s) related to a CT Scan of my abdomen. Here is a brief timeline:
November 2017 - Seen for abdominal pain, nausea, and acid reflux with chest pain (still ongoing).
December 2017 - Endoscopy (normal)
January 2018 - CT Scan
CT Scan Findings:
Best demonstrated on the axial and coronal reconstruction (axial image 40, coronal image 47) is a 1 cm rounded soft tissue density at the junction of the second and third portion of the duodenum near the expected location of the ampulla.
Impression:
1. Negative for bowel obstruction, focal inflammation or fluid collection.
2. Possible small 1 cm polyp or mural nodule at the junction of the second and third portions of the duodenum near the expected location of the ampulla.
My GI doctor said not to worry and follow up in 3 - 6 months. I have followed up at 6 mos and he told me this was "high risk" and I needed an endoscopy. The diagnosis he listed was, "benign adenomatous neoplasm." I am shocked that it sounds more serious now than when my CT scan results were initially presented.
Questions:
1. Does the CT Scan findings/impression indicate something benign? I cannot imagine how he would know it's benign from the CT Scan alone. He does not seem worried about this aspect, but I am about malignancy.
2. How serious is this if it is benign? He seemed more worried about it being a "high risk removal.
3. Should I have another CT Scan since it's been six months? I feel that is a long time.
I really appreciate your help on this worry.
Brief Answer:
Endoscopy/Biopsy
Detailed Answer:
Hi,
1. CT images can indicate whether a lesion is benign or malignant. But ultimately a biopsy and a histopathological examination is needed many times for confirmation.
In your case, with the CT scan alone it is difficult to say whether it is benign or malignant. A biopsy and histopathological examination is needed to know whether it benign or malignant.
2. Benign means not cancerous. So it is not serious. But what kind of lesion it is will be known only by histopathological examination.
3. There is no need for another CT scan. Endoscopy may be done to look directly at the lesion in duodenum and get a biopsy done.
Regards,
Dr. R. K.
Endoscopy/Biopsy
Detailed Answer:
Hi,
1. CT images can indicate whether a lesion is benign or malignant. But ultimately a biopsy and a histopathological examination is needed many times for confirmation.
In your case, with the CT scan alone it is difficult to say whether it is benign or malignant. A biopsy and histopathological examination is needed to know whether it benign or malignant.
2. Benign means not cancerous. So it is not serious. But what kind of lesion it is will be known only by histopathological examination.
3. There is no need for another CT scan. Endoscopy may be done to look directly at the lesion in duodenum and get a biopsy done.
Regards,
Dr. R. K.
Above answer was peer-reviewed by :
Dr. Yogesh D
Dr. R.K.:
Thank-you for your details answer, but I have a few follow-up questions:
1. My doctor stated that he used a forward-facing scope during the first endoscopy and did not see the neoplasm. During the second endoscopy he will use a forward and side-facing scope. How likely is it that he would have missed the neoplasm during the first endoscopy, given it's location on the CT Scan?
2. How likely is it that the CT Scan could be a false positive? I guess since it wasn't seen during the first endoscopy, maybe this is a false alarm?
3. The CT Scan is 6 months old and shows the polyp/mural nodule as 1cmm in size. Is this a significant finding? The rest of the CT Scan was normal (pancreas, etc...), so how much could it have potentially spread if malignant?
I really appreciate all your help with this concern.
Thank-you for your details answer, but I have a few follow-up questions:
1. My doctor stated that he used a forward-facing scope during the first endoscopy and did not see the neoplasm. During the second endoscopy he will use a forward and side-facing scope. How likely is it that he would have missed the neoplasm during the first endoscopy, given it's location on the CT Scan?
2. How likely is it that the CT Scan could be a false positive? I guess since it wasn't seen during the first endoscopy, maybe this is a false alarm?
3. The CT Scan is 6 months old and shows the polyp/mural nodule as 1cmm in size. Is this a significant finding? The rest of the CT Scan was normal (pancreas, etc...), so how much could it have potentially spread if malignant?
I really appreciate all your help with this concern.
Brief Answer:
Answer given below
Detailed Answer:
Hi,
1. As per the CT scan, the lesion is in the junction of second and third part of duodenum. A side viewing scope is a better scope to look for lesions in that location. There are chances it may be missed in a forward viewing scope.
2. Since it has been described as a 1 cm lesion it is less likely to be a false positive one. But as said earlier it is difficult to say whether is benign or malignant.
3. 1 cm is an insignificant thing. Even if it is a malignant one, it is difficult to say how much it can spread within this 6 months.
I would advice you undergo a repeat endoscopy to look for the lesion in the duodenum and a biopsy.
Regards,
Dr. R. K.
Answer given below
Detailed Answer:
Hi,
1. As per the CT scan, the lesion is in the junction of second and third part of duodenum. A side viewing scope is a better scope to look for lesions in that location. There are chances it may be missed in a forward viewing scope.
2. Since it has been described as a 1 cm lesion it is less likely to be a false positive one. But as said earlier it is difficult to say whether is benign or malignant.
3. 1 cm is an insignificant thing. Even if it is a malignant one, it is difficult to say how much it can spread within this 6 months.
I would advice you undergo a repeat endoscopy to look for the lesion in the duodenum and a biopsy.
Regards,
Dr. R. K.
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Above answer was peer-reviewed by :
Dr. Chakravarthy Mazumdar
Answered by
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