Bone scan shows uptakes at ribs
My mother was just diagnosed with ILC. Biopsied tumor is on the left side. Skin and chest wall are involved so the oncologist is trying to determine metastases now. He ordered a bone scan and chest/abdomen/pelvis CT. Bone scan shows 2 focal mild to moderate uptakes on 2 of the right ribs. Without CT correlate. Impression is "cannot exclude osteoblastic metastases to the right ribs. Consider follow-up bone scan in 3 months, or radiographs earlier if either side becomes symptomatic". She feels chest pain both sides from time to time.
Is this any further imaging exam to confirm this? I read that PET-CT is most accurate but she just took a CT (allergic to CT contrast dye, used Prednisone / Benadryl protocol), so that's a lot of radiation in a short period of time. Is chest MRI a good next step? She had a breast MRI coming up but does it do the same as a chest MRI?
Also how accurate is the CT in regards to bones and organs? It says a few low density lesions on liver and kidney are too small to definitively characterize, and also notes nodular thickening of adrental gland and thickening bladder wall. I read that ILC can have uncommon metastatic sites. What could be the next step to investigate these further? Does MRI work well for abdomen and pelvis areas?
Any suggestions are welcome. Thank you! And wish everyone a happy and healthy new year!
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If it's not going to change her treatment they may not want to do more scans right now. It won't provide any additional benefit and it unnecessarily exposes her to a lot of radiation. I'm in a similar boat. I may or may not have mets in one vertebra (CT/PET disagreed) and there's a lung nodule that was too small to tell what it was. But finding out for sure wouldn't change my treatment plan, so we'll just see what shows up on the next scan.
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If this is the first time she's had imaging, or imaging in a long time, they will report EVERYTHING and it looks really scary. Lots of scans throw up lots of incidentals and you can be going down all sorts of rabbit holes for no reason. The breast cancer is the key thing right now and if CT and bone scan aren't correlating that is a fairly good sign (and taken together they are essentially the same as a PET/CT). MRI is better used for bones - for example, i get a full spine MRI every 9 months so they can keep a better eye on my vertebral mets/spine structure with better imaging however they are also within the CT chest/pelvis view - you can see them, but the image isn't as sharp, they just look like a white blob.
Parakeets is right, though, this outcome won't change her current treatment plan and its more important to get her on treatment which, if they are mets, would clean them up and if they aren't well, then you just saved a bunch of time worrying about nothing and exposing mom to incidental scans and radiation.
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Agree with the above responses. Unfortunately sometimes we have to wait until the next scan to determine if something is brewing. I myself am waiting on a couple lung nodules that are suspicious for mets. It's definitely not fun waiting but is necessary.
So typically yes CT is good for evaluating organs and also can see bone mets. MRI is also used in the scenario of small indeterminate lesions on liver , kidney etc. CT and PET/CT are typically ordered to start to r/o mets. Depending on what is seen then MRI, bone scan etc to follow. MRI is typically is not the first study of choice for the chest, CT is. Also the breast MRI is just to evaluate the breast tissue.
Hang in there, you are on top of things and doing the best you can! Best wishes.
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