Hi everyone! Thanks for all of your prayers and support. My mother is still waiting for results from two biopsies on her left breast - which underwent a lumpectomy last November for Stage 1, estrogen positive breast cancer. No lymphs involved. Due to lung issue radiation had to be put on hold - but the 11 rounds of chemo she had for the lung was also applicable for the breast cancer, so her doctors are confident any wayward cells were killed. She just started taking irrimidex.
My question: She had two spots show up on her first mammo this week post-surgery around the site of her sentinel node biopsy. The doctor has no idea what they are - recommended waiting for an MRI but my parents insisted on a biopsy instead - we'll get results hopefully today.
Since my mother has had a PET scan, and numerous CT scans of the chest since the breast operation (the most recent being about 6 weeks ago), wouldn't this show up if it was cancer? I'm curious what shows on a mammo but not on a CT scan, or vice versa.
Any advice would be greatly appreciated! Thanks so much!
Amy
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Need advice on CT Scans vs. Mammograms
- By peace33
- Posted September 25, 2009 at 8:55 am · 1 reply
- In What, me worry?
- Shared with the public
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1 reply
- By gpawelski
- Posted September 25, 2009 at 9:57 am
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Pet Scans, MRIs, CTs, etc., are diagnostic tests (ordered to answer a specific question) as opposed to a screening test (ordered to try to rule out a particular condition). One diagnostic test may be used in combination with another diagnostic test to help make a diagnosis or follow a patient that has undergone treatment. A biopsy may be required to confirm a diagnosis.
A word about pathology reports.
Pathology is a very visual science. The pathologists look for patterns. It appeals to people who have a talent for recognizing patterns. Cancer grows in recognizable patterns that allow for their identification. Biological characteristics are exactly what pathology reports provide. A breast cancer has a certain growth pattern that differs from a carcinoma of the lung. Benign conditions also have patterns.
However, in between a diagnosis of benign cells and a malignancy are a dizzying array of possibilities, and sometimes more often than you'd expect, the pathology report is wrong. Researchers at Johns Hopkins have found that about 1.4% of the time, a pathologist mistakenly diagnoses cancer, gets the type of cancer wrong or misses a cancer altogether. Errors that can significantly change the type of treatment are even more common.
Even two different pathologists looking at the same cells can reach different conclusions about who has cancer and what type. Pathologists can readily distinguish between big invasive cancers and normal tissue, but they disagree about what to call cancer in a large gray area in between.
Usually, a pathologist will never make a diagnosis unless they are 200% sure of the diagnosis. Having said that, there are situations where a definitive diagnosis cannot be rendered. Sometimes it is because a biopsy sample that was taken by the surgeon is too small, or perhaps taken from an area that is not representative of the patient's lesion. Other times, the diagnostic process of key cells may be obscured by inflammation or the effects of treatment such as chemotherapy.
There are times when a pathologist must admit that they do not know. Considering that the rarest of diseases pass under the pathologists' microscope, this is not surprising.
There are occasions where the pathologist may turn to an immunohistochemical (IHC) diagnostic staining test performed on microscope slides, with intact cells and looks for proteins themselves. In a statistical analysis, the tentative diagnosis, the interpretation of stains and conclusions drawn from IHC are independent factors in reaching a diagnosis. An IHC is just furthering of the investigation of the tumor specimen when the original pathology is really unsure.
And if this test is not helpful, the pathologist may turn to a consultant, a recognized expert in their field. The emergence of telepathology may also provide another source of immediate consultation for the pathologist. If a pathologist were able to send the microscopic images they are viewing to another expert, in real time, the benefits for the patient may be immense. With the growth of the internet, digital images can be emailed for future group discussions.
So, the first step in any cancer diagnosis is to tell your doctor you want a second opinion from a pathologist who specializes in your type of cancer. Insurance almost always covers the cost. Major cancer centers typically have several specialized pathologists.
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