Other Imaging Tests Prior/After Surgery?

macdebbie

I've just been reading on the American Cancer Society website about some imaging tests that can be used to assess the extent of the breast cancer in a woman after diagnosis.

The only one I knew of before reading this was a breast MRI and my BCS told me I "didn't need that". Now that I am reading this, though, it makes me wonder why that or something similar isn't used?

Why wouldn't a surgeon want to know the extent of the cancer before surgery? Couldn't it save the person having to go through potentially unnecessary radiation? Do they not do these advanced imaging test due to cost, and if that's the case why do they care about the cost since the insurance pays for it?

Maybe I'm not understanding this, but it seems a bit archaic to radiate someone "just in case" there are other cancer cells out there.

Why not be sure if there are in fact other cancer cells in the breast via these advanced imaging methods before giving people treatments that are not without serious side effects?

exbrnxgrl

Here is a quick answer: If you are talking about PET or CT scans for lower stage patients, it is not considered standard of care. They are very expensive, a PET is about $ 5,000, they expose you to a lot of radiation, no scan can see bc cells. They visualize areas that have already grown big enough to be seen. If you are speaking about bc cells in the breast, surgery will take care of that. Lumpectomies generally require follow up rads because no imaging nor surgeon can see bc cells until they grow to a certain size. Rads is meant to mop up the cells which may be there but cannot yet be seen.

Your doctors probably do not care about the cost of imaging. It is the insurance company who may deny it because it is not standard of care for lower stage patients. BTW, it’s not the insurance company who pays for it ! We all do when we pay our premiums, co-pays, etc. Those who are paying their premiums and don’t use a lot of medical care are paying for those who do and insurance companies want to keep those costs down, That is why they follow standard of care guidelines in their approval process.

Again, all the imaging in the world will not be able to detect teeny, tiny cells floating around your breast. Imaging does not look at every millimeter of breast tissue at the cellular level. That is why rads generally follow a lumpectomy. Hope this helps and take care

ShetlandPony

If a woman has extremely dense breast tissue on mammogram, that can make breast cancer difficult to detect, so a breast MRI can be useful and justified for that. Also if the diagnosis is lobular breast cancer (ILC), it can be more difficult to detect, and breast MRI is the best scan to rule out any other tumors before surgery. The downside of breast MRI is that it is very sensitive, meaning it sees a lot of stuff, but not very specific, meaning it doesn't tell you exactly what it is. This may result in more anxiety, biopsies, etc. so that is another reason to only use it in certain situations.

As exbrnxgrl says, no imaging modality can see microscopic cancer, so that is the reason for pairing lumpectomy with radiation, which gives similar survival rates to mastectomy.

I applaud you for reading and asking questions. It's a steep learning curve for sure. And frustrating that even with all the medical knowledge that is out there, cancer still presents us with so many unknowns. We do the best we can with what we know.