Inconclusive MRI/Bone scan negative

ASole

I was diagnosed with IDC in 2017 at age 33, did a single side mastectomy, no lymp node involvement and then four rounds of taxotere, no radiation. I completed 18 months of tamoxifen and was given the go ahead to come off it and try for children. I got pregnant July 2020 but ended up miscarrying. I continued to do my normal six months scans and this December it was noted 2 maybe 3 enhancements on the ribs on my mastectomy side in my annual MRI. They sent me for a bone scan and nothing showed up. Note, my labs are all in normal range and I have no pain on ribs or in chest area and I work out pretty heavily so any major pain would be noticeable. The breast board (I'm a Kaiser Perm patient) is making the recommendation I restart tamoxifen and get rechecked in six months. Starting tamoxifen will obviously pause or completely shut down any plans of children. I don't really feel comfortable with the suggest protocol as nobody has told me what it could be beside a potential re-occurrence. Of course my health is the most important but just looking for additional advice or if anybody has an enhancements noted on their MRI and it ended up being nothing. Is there something I should press for?

LivinLife

There is a lot packed into your post and questions. My response will barely address any of that... I can only speak to "non-mass enhancement" and you truly mentioned "enhancement." In my case, post surgery, the non mass enhancement from MRi was found to include over 3+ cm of benign and precancerous conditions... Prior to any of that diagnostic mammogram saw 3 cm and biopsy found DCIS... the DCIS ended up being a much smaller area than that with the non mass enhancement making up the bulk of things. You are also talking about "on the ribs" which may not relate to anything I've mentioned at all? Hopefully others will chime in before long.... Best!!!

Beesie

Asole, I found this thread, which is at least one example of MRI enhancement on a rib that turned out to not be cancer:

Topic: New enhancement in ribs, chest wall on MRI

While I haven't had rib lesions, I did have a breast MRI that had an incidental finding of a lesion on my spine. That turned out to be nothing serious at all - just a benign lesion.

I would hope that if your doctors felt that the risk that this might be mets is high, that they would recommend more than follow-up imaging in 6 months. Have you asked about a CT scan or PET scan? My understanding (very limited, mind you) is that those are best for detecting bone mets.

Anonymous

Well, the radiologist has to report everything seen and, short of a biopsy, probably can't be determined at this time if its actually mets, hence the wait and see and rescan in 6 months advice. The fact that it wasn't picked up on the bone scan was good, as those tend to be rather sensitive and would have shown activity if it was mets, as well as the lack of urgency in wanting to biopsy at this time. So the signs are pointing towards likely not mets, especially given your original diagnosis, although this is BC we are talking about and we all know it can toss up surprises all the time.

I have seen a few women on this site have rib enhancements show up before and give them a scare, but turned out to be benign and they remembered they had taken quite a knock some months prior. On the flip side, not all mets necessarily cause pain - sometimes they are picked up in incidental scans before they cause pain. A CT may give another view or it may be a similar issue of watch and wait.

Your options are to either take the advice, get a second opinion, or disregard the advice and continue trying for children in the interim. Im not on tamoxifen so don't know how that works - have you checked in to the hormone therapy thread? Younger ladies there (who do want children) may be able to give you some thoughts as well.

ASole

Thanks. Yeah unfortunately tamoxifen and pregnancy don’t mix. Just feel like I’m between and rock and a hard place. Guess I just got to keep pushing for answers until I feel comfortable with a decision. Frustration is just high because they haven’t really told me what else it could be so I’m left worrying I have a tumor

ASole

MRI lists it as a heterogenous enhancement within Right upper ribs adjacent to sternum.

BevJen

ASole,

If you can get a copy of your MRI disc from the place where you have your imaging done, as well as a copy of your report, you can send them off for a second opinion without having to go there yourself. One place that I know of for sure that does this is the Cleveland Clinic. I think your doc may have to sign off on the form, but I'm not positive. There is a charge that probably would not be covered by insurance, but it's reasonable as I remember -- maybe a couple hundred dollars?

Good luck.

Anonymous

Well, a quick search online and this study came up, which seems to follow with current plan of action and may give you some comfort:

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC53862...

Concurrent lesions of rib and other sites were more likely to be rib metastasis compared to pure rib lesions (P < 0.001). Moreover, multiple rib lesions and lesions located on bilateral ribs were more likely to be rib metastasis (P < 0.001). Our data suggest that patients with pure rib abnormalities could be recommended for follow-up only. However, if concurrent lesions of rib and other sites were detected on bone scans, additional radiological examinations should be performed to patients.

Have you spoken with the MOs about how best to weigh your desire for children with what they are proposing?

LivinLife

BevJen that's a really good idea about getting the CD! I actually get annual testing done at Cleveland Clinic every year for a different medical reason. Each year after my echocardiogram I fill out a release and get a copy of the CD of the echo while there free of charge with no other signature needed other than the release I sign. I've done that at other medical institutions too for no charge - 2 others. They often will only provide one CD. I've shown up to appointments, like cardiology - I go to Pittsburgh for that - and they never received a report or imaging so that taught me to get important things like this so other docs can load them into their systems. I keep the originals for any future docs in different systems I may see....

BevJen

LivinLife,

Also, if your hospital/doc is linked into the Epic system (mine is called MyChart -- I think some other places call it something else) any consulting docs can sign into your chart and see all of the reports there (they won't get the scans, though -- only the reports -- so that's something to remember.)