Best imaging method for dx mets?
 

I finished Herceptin in Dec. 09. End of July began having pain on right rib cage side. This has now been going on 6 weeks. This pain is oddly familiar to me from when my liver enzymes were 3x elevated during chemo Spring of 09. It is a dull achy pain. Comes and goes but is definitely every day. Rib x-rays and ct of abdomen show nothing. Liver function test normal. Onco is leaning towards a pet scan but also mentioned ultrasound or mri. Is there a gold standard for diagnosing this area (liver) after bc? My bc was missed for 2 years because it didn't show on imaging so I am understandably concerned that they just aren't ordering the correct imaging study. I am in the military system of medicine so insurance/money no problem. They are not restricted in what they can order. ANy advice greatly appreciated!

Re: Best imaging method for dx mets?
 

An "eye to thigh" PET/CT scan would probably give the most information overall. If money is no object, an MRI might give additional detailed information on the specific area...without added radiation.

Looking at your history, have you considered a hormonal therapy?

Re: Best imaging method for dx mets?
 

I tried Tamoxifen twice in the last year for months at a time with debilitating side effects. I'm not sure what that has to do with my imaging question, though.

Re: Best imaging method for dx mets?
 

Just being nosey ;) Actually, I was just curious if there were oncs that didn't value that part of pathology when her2 +. Wish there were more endocrine options for adjuvant.

Re: Best imaging method for dx mets?
 

I would request PET/CT if your really concerned. Also just wanted you to know that so many of us women that have had mastectomy have experienced rib pain. Seems to be a common complaint with so many of us. But it's good to stay vigilant and get things checked out if your worried...nothing like peace of mind. Once dx with bc ever new pain we feel worries us...it's so hard at times. But it really might be nothing more then the fact you had a bilat mastectomy. Hang in there.

Chelee

Re: Best imaging method for dx mets?
 

Koryn,

While a PET/CT can be indicative of cancer if the nodule is about 1 cm and therefore has a greater chance of lighting up, I'd prefer a liver MRI. The MRI would give a detailed review of the liver and reveal any nodules, including benign nodules, that might have been missed by a CT scan. Overall, my sense (and it's only my gut feeling) is that if you're experiencing pain, the cancer would be big enough to show up on any of these tests. And a second test can really help rule one way or the other.

What does the radiologist's report say? His or her impression? Does he or she give a recommendation for follow-up? Six months? etc.? It's important for you to get all copies of your reports. Perhaps only a follow-up is necessary.

Also, in reference to Tamoxifen, you were blessed in being ER+/PR+. 70% of breast cancers are. The reason it's a blessing is because Tamoxifen and related endocrine drugs have cut the rate of breast cancer recurrence by 50% in 25 years of use. By recurrence I mean the cancer spreading to stage 3, or locally advancing to lymph nodes, for example, or becoming stage 4 and invading another organ (not to be confused with coming back in the other breast, which would be another primary breast cancer, not a recurrence). That said, you should speak to your onc about an alternative to Tamoxifen.

It's possible that the rib pain was caused by the mastectomy and silicone implant. I had DIEP flap reconstruction and my ribs bothered me for quite some time.

Joan

Re: Best imaging method for dx mets?
 

Koryn,

My recurrence was missed for 4 years because they thought the shadow was 'scar tissue', so I understand your concern.

Earlier last year, I had gone throught similar worries and discovered a hepatic hemangioma in my liver. I think the 'ultrasound' is recommended because it will confirm the nature of the mass, if there's ever one showing on the CT because hemangioma would show on one scan but not the other.

Since all your lab work was good (just like mine last year), I'm thinking an ultrasound will solve the mystery and get rid of your worry.

Re: Best imaging method for dx mets?
 

MRI with contrast and PET/CT as Rich said.