Interpreting radiologic findings
Dear OncoLink "Ask The Experts,"
I am a Stage 4 breast cancer survivor. I have been through chemotherapy. I also had a stem cell transplant. The cancer cells that were in my lungs and the tumor on my liver are not present. There have been hot spots on my spine and other bones in my body. They still show up on the bone scans. How do the doctors know for sure that these places are cancer? I have had a lot of falls on my back and neck. I have also been diagnosed with fibromyalgia and arthritis. Can a pathologist distinguish what the hot spots on a bone scan are?
Lawrence J. Solin, MD, FACR, Professor of Radiation Oncology at the University of Pennsylvania, responds:
Determining whether or not radiologic findings represent cancer can be a difficult problem. Looking at all of the radiologic studies, comparing current studies to old studies, and comparing different types of studies (for example, bone scans, MRI scans, and plain x-rays) as well as knowing the patient's clinical course usually give strong suggestions as to the meaning of any particular finding. Doing a biopsy can confirm radiologic findings, but there are some good reasons not to do a biopsy for all patients. For example, a biopsy procedure is invasive, can be associated with complications, and may be painful. Also, while a positive biopsy for cancer is valuable, a negative biopsy does not necessarily mean that there is no cancer. Finally, if the disease has already spread, then doing a biopsy may not add any useful information.