Additional imaging studies after diagnosis?

arlva24

Hi all,

Thanks so much for all the information you've provided. I wanted to see if others could provide a list of additional imaging studies that they had after initially being diagnosed with IDC. Thanks in advance!!

Mountainlover

Hi, I'm sorry you're finding yourself here, I hope you get a clear plan soon.

I was diagnosed further to a yearly mammo+US followed by biopsy. I then had MRI with contrast, CT thorax and abdomen , and bone scan. I was told that's the usual pre-surgery procedure here in Belgium.

As the MRI showed other areas of concern in my breast, more US and biopsies followed. This changed my treatment plan from lumpectomy to MX due to the multifocality. Now I'm glad they did the MRI as only the largest nodule was picked by mammo.

All the best.

MountainMia

I had the screening mammogram, a diagnostic mammogram, ultrasound, and needle biopsy for my IDC and DCIS diagnosis. My hospital does not "routinely" do any other scans, such as MRI. They are only prescribed if there is a specific reason to look for something else. I'm in the US.

Edited to add: prior to radiation I had a chest CT, which was using in determining the angle of attack. And during the process of chemo each of my blood tests included liver function tests.

edj3

I'm also in the US and also had the 3D screening mammogram, the diagnostic mammogram, an ultrasound, and a biopsy. Then I had a breast MRI which picked up a tiny pleural effusion on my left side (cancer side) so I asked for an x-ray to look at that more. Based on the size and some previous images, the radiology oncologist is confident I've had that for a long time and it poses no threat.

NancyD

Well, it's been some time, but I think it went like this: screening mammo, diagnostic mammo, core needle biopsy, PET/CT, then right into neoadjuvant chemo. I know I had a breast MRI somewhere along the way, but that might have been just before my surgery to guide them. Had another PET/CT before surgery, too.

Salamandra

I was treated in NYC. I had an MRI after my initial diagnosis and first appointment with my oncologist, to rule out anything else in my breasts. I got the impression this was standard but it might have been related to my age at the time also. That didn't show anything of concern, and that was the end of my imaging.

Now I alternate between MRIs and mammograms for ongoing screening. I requested the MRIs and I think due to my relatively younger age and family history of breast cancer, my oncologist prescribed it and my insurance is covering it.

Beesie

There is not a one-size-fits-all answer. The additional screening you get may depend on your diagnosis and the surgery plan. What is appropriate for someone who is clinically (pre-surgery staging) Stage IA is different than what is appropriate for someone who is clinically Stage IIIA or IIIB. And for those who are having neoadjuvant treatment, (eg. chemo prior to surgery), more imaging may be done prior to the start of treatment.

For the breasts, some surgeons like to do an MRI prior to surgery, mostly to confirm the size of the area to be removed, and to confirm that nothing else is going on in either breast. This is optional and seems to be up to the whim of the surgeon.

As for full body scans, the NCCN Guidelines, which are the gold standard guidelines used in the U.S. (and for the most part, in Canada too, where I am), do not recommend CT/PET or bone scans for those with an early stage diagnosis unless metastasis is suspected. Some surgeons and medical oncologists choose to do them, however.

arlva, what is your preliminary diagnosis?

arlva24

Hi Beesie,

My initial diagnosis is 0.7 IDC that is ER+/PR+/HER2-, grade 1. They're doing an MRI to assess whether there are additional tumors - that is scaring me a little because mammograms are not useful for me (extreme density), and the surgeon noted that my breast on that side is "lumpy." The tumor felt very different, though, from the rest of my breast tissue - it felt like an extremely hard marble. It was only diagnosed on ultrasound - the mammogram did not show it. The ultrasound report indicated that the axillary nodes appear normal - I'm not sure how strong a piece of evidence that is.

The first two steps were genetic testing and an MRI, which is scheduled for this Thursday. One question that I have is how they know whether a tumor is metastatic or not based on the initial pathology just from the tumor? Does the grade play a role in that?

Thanks again to everyone for all of your helpful answers. This site has been a huge benefit to me in learning more and asking the right questions.

moth

I think we need to be clear on what we mean by 'scanning'

There's

-further imaging of the affected breast

-imaging of the contralateral breast

-imaging of the chest/abdomen/brain and bone scans

Only the last one can show metastases. The chest/abdo/brain scans are usually not perfomed for early stage breast cancer unless there are other symptoms or clinical presentations (tender areas of abdomen on palpation for example) or blood test abnormalities.

Beesie

"One question that I have is how they know whether a tumor is metastatic or not based on the initial pathology just from the tumor? Does the grade play a role in that?"

There is absolutely no way to know if a cancer is metastatic from the pathology of the tumor or the in-breast and nodal presentation. As moth indicated, it's CT scans, PET scans and bone scans that are used to find mets. The reason these full body scans aren't done on early stagers is because even these scans can only find mets that are above a certain size - and if someone has an early stage cancer, it is very unlikely (but not impossible) that they would have a metastatic tumor that is large enough to be found. What these scans do find are lots of benign abnormalities that many of us have. So for early stagers, these scans are more likely to result to a false positive - leading to unnecessary biopsies and a lot of anxiety - rather than actually finding mets. This is why these scans are generally not done unless someone presents with symptoms that could represent mets.

And this is also why endocrine therapy (Tamoxifen or the AIs) and/or chemo is given early stage patients. These are systemic treatments, which go into the body and track down and hopefully kill off any rogue cancer cells that might be floating around, too small to be detectable as mets but with the potential to develop into mets.

AliceBastable

Mine was found on a regular mammogram, then I had an ultrasound and biopsy on the same day about a week after the mammogram. My surgeon has breast MRIs done on her patients, so that was the next step - and the worst part of all of it. Horribly uncomfortable. I already had an appointment set up with the oncologist due to some iffy blood work, and she scheduled a no-contrast chest CT because I was a smoker and she wanted more detail than an x-ray would give. That found a good-sized growth on my kidney. A few weeks after the lumpectomy, I was scheduled for a contrast CT of chest, abdomen, and pelvis, and also a bone scan. I doubt if I'd have gotten those scans if I hadn't had the other unrelated cancer. Unless there's a medical reason for those scans, most insurances won't approve them.