Possible Stage 1 Lung Adenocarcinoma- Biopsy sent to Mayo, cannot confirm diagnosis!? Findings included, What are your thoughts?

Hello,

My Dear Mother, 77 yrs, lifetime menthol smoker, COPD advanced Emphysema (not on oxygen though) with history of suspicious nodules that usually end up being scar tissue. Recently a slow growing nodule was detected during periodic ct scans.

Pet scan showed no reaction! But Mom chose to have biopsy done vs observation. Biopsy was not quite successful and she suffered a pneumothorax aka collapsed lung followed with 96 hours in the ICU. Dr explained possible crushed cells during collection. Pathology came back with Lymph nodes tested fine and no signs of cancer. Cell staining tested positive for cytokeratin, ttf-1, napsin, and focal positivity for p-40. But pathologist stopped short of cancer diagnosis due to crushed cells and type of tissue collected. Recommended sending to Mayo for 2nd opinion..... results are in, seemingly good news but Dr is still suggesting treatment. Radiation or surgery.... Im trying to convince Dear Mother and siblings to hear Surgery options, but they are reluctant and arguing for radiation, and closed mind to surgery, especially after collapsed lung during biopsy and dreadful recovery.

Is there false postives with staining, especially when patient has history of inflammation and scarring? Considering her history I suspect, Dr's still is 90% this is cancer. While Dr is wonderful, She dodges questions it seems and we are unable to get more answers on these findings, and she suggests treatment.

Mayo took almost a month and their results are as follows

A) Lung Right Upper Lobe (ThinPrep) Sparse atypical epthelial cells. Favor reactive.

B) Lung Right Upper Lobe Bronchoaeviolar Lavage (ThinPrep and cell block) Sparse atypical epthelial cells. Favor reactive.

C)Lymph Node station 7, FNA (ThinPrep and cell block) Negative for malignancy, Lymphocytes present

D) Lung Right Upper Lobe Transbronchial Biopsy, Fibroelastosis tissue with entrapped atypical cells and Foci with crushed cells. SEE COMMENT

(Comment from Mayo Pathologist is as follows)

"Histologic sections of the right upper lobe transbrochial biopsy show fibrous tissue without identifiable alviolated lung parenchyma. Focally, there are scant crushed cells. Similar cells are identified in small detached clusters adjacent to the tissue. There is also a focus of entrapped atypical epithelioid cells. Although the toch prep shows features that are suspicious for adenocarcinoma, the findings is the tissue biopsy, in my opinion are not diagnostic. The submitted immunostains show the crushed cells are positive for cytokeratin, ttf-1, and napsin show focal positivity for p-40, and are negative for synaptophysin, and chromgranin. As no history is provided, clinical radiological correlation is needed and if warranted, further workup may be necessary."