No biopsy after positive PET results?

34 Female

History of Rheumatoid Arthritis, enlarged liver, and lumbar fusion/decompression surgery

Noticed an enlarged lymph node in august of 2020, with several more to follow. All nontender and firm.

Symptoms: excessive fatigue, frequent pruritus/itching, dizziness, nausea, short of breath, cough, and some cognitive symptoms such a fogginess, disorganized thoughts, and brief memory loss, all since the fall of 2020. Brain MRI ruled out the presence of a brain tumor, etc.

Lymph node tenderness with alcohol consumption and a rash occurring the past 3 months, along with an increase in dizziness.

CT scan confirmed enlarged lymph nodes (around 15 mm) in the neck and axillary region, as well as numerous lymph nodes in the neck, axillary, and chest that were slightly below the cutoff of 10 mm. The lymph nodes did not have the appearance of reactive nodes due to an infection, nor did they show evidence of malignancy. Autoimmune labs were negative.

A PET scan was then given. The cervical lymph nodes were active with an SUV max of 3.5

and the axillary nodes showed an uptake SUV 4.7

Liver SUV max was 4.1

According to literature, an SUV max value above 2.5 indicates malignancy.

An SUV value above the liver's SUV is considered a Positive PET scan result, and should be considered malignant until proven otherwise (by a biopsy). But there is only a 4% chance of having a false positive.

So, if I was your sister, what would be the next thing you would want to do? Probably a biopsy?

My hematologist said that my result was negative and she will see me in 6 months for an ultrasound. It was clearly a positive result.

I am confused. My oncologist was thinking it's probably lymphoma with the amount of visible lymph nodes in my CT, which is why he sent me to the hematologist. She has blown me off, telling me over and over that I definitely don't have lymphoma but cant give me a legitimate, reassuring reason, and she does not acknowledge my symptoms at all.

I am kind of wondering if the "mood disorder" and "anxiety" listed in my chart has made her believe that is the reason I "think" I am sick. When I first went to get checked out last fall, that doctor didn't feel my lymph nodes nor did he listen to my symptoms. He kept repeating "no it's just because you have to take mental health medication."

I just want to know what you would think.

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