Bone scan results discordant with CT

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I've been tilting at windmills for several months, trying to determine whether or not there are small mets on my spine (per 2 CTs at university hospital) or not (per 2 CTs at my local hospital) (and yes, that's a lot of scanning!!). My MO and I discussed options at length and he sent me back to the university for one more CT and a nuclear bone scan. I had a bone scan a year ago just after my recurrence, and it was clear. Three days ago my MO called me with preliminary results - CT shows nothing on my spine (yea! although I have no idea why I had lytic lesions over 2 different CTs, but I'll deal with that later). But bone scan shows lesions on my 6th left rib and 10th right rib - but these aren't seen on the CT. So my MO called the radiologist who explained these lesions weren't present a year ago but are indicative of metastatic disease. *sigh*. I now have an MRI scheduled for next week.

My understanding is the bone scan is the "gold standard" for mets, but I still have some hope (since I have yet to get any truly solid confirmation!). What will the MRI show that would be different from the bone scan? Not gonna lie, I hate MRIs and I'm already in a bit of a panick (even with Ativan on board they're tough).

Thanks for any ideas you might have.

Comments

  • bevin
    bevin Member Posts: 1,902
    edited February 2017

    Goodness , I am sorry you are facing this. I just wanted to pop in and give support to you. I know others with experience will be by soon to give input. Best wishes

  • pepper43
    pepper43 Member Posts: 103
    edited February 2017

    Breathe. Do things to take your mind off it (silly movies/TV) until the MRI and hope for the best, brace for the worst. And know too that even those who do wind up having metastatis can live a long life. Sending you virtual hugs.

  • Emily2008
    Emily2008 Member Posts: 605
    edited February 2017

    From what I understand, the MRI would be more likely to give a false positive than a bone scan for bony mets. So I do believe bone scans are as good as it gets for detecting bone mets.

    Ugh, I'm so sorry. And what a nightmare having to do all those scans only to get disparate opinions!

  • Maureen1
    Maureen1 Member Posts: 614
    edited February 2017

    (((Nancy))) thinking of you...wish you didn't have to go thru this...I hate MRI'S too but they are one of the best diagnostic tools - hang in there, I had to take several Ativans and keep my eyes closed to get thru my last one - no matter what, I closed my eyes before I went into the tube and didn't open them until I was completely out. I also asked for a wide bore machine - I heard that MSU clinical center in East Lansing also has an open MRI? Let us know how you're doing... hopefully the MRI can finally figure out what's really going on...keeping my fingers crossed...Maureen

    Heart

  • Hopeful82014
    Hopeful82014 Member Posts: 3,480
    edited February 2017

    So sorry to read all this, Nancy. To be facing metastasis AND getting such discordant results is awful. Sending lots of lots and support (((Nancy)))

  • mazie73
    mazie73 Member Posts: 74
    edited February 2017

    In my experience, bone scans show more than CT scans. Have you had any possible rib fractures? Scar tissue from a surgery showed up on my bone scan (lower left sinus area). Radiologist ID'd it as an area of concern and my MO just laughed — not someplace breast cancer lands. (And it always shows up on my dental x-rays.)

    I've had two MRIs. Just make sure you're comfortable — the pre-warmed blankets are always nice. I've found the machine's sounds to be oddly meditative, too. I almost feel asleep once!

  • NancyHB
    NancyHB Member Posts: 1,512
    edited February 2017

    Oh ladies - It's been quite the day, and your kind words and support really help.

    I came home to find the disk and reports from UM - I forgot I'd called last week and ordered them, and here they are. So I opened the packet and reached for the first report which was the CT, and the first two lines say: "History: Metastatic breast cancer. Follow-up study."

    So there's that.

    As my MO already told me, the CT didn't find anything on my spine, and that's what the report states. It notes the sclerotic lesions on my pelvis (we already knew about those and suspect they're benign bone islands). Liver is unremarkable, everything else looks good. Suggests correlation on sclerotic lesions with bone scan.

    Bone scan notes uptake of tracer on the anterior left seventh rib and posterior right 10th rib - not clearly identified on previous bone scan (so were they there but faint? Hmmm...) It also says "The CT scan shows a sclerotic lesion on the 10th right rib" but the CT report doesn't mention this. *sigh*. Oh, and degenerative patterns in my shoulders and knees (I'll take that!)

    Ultimately, "new foci of increased uptake in two ribs compatible with metastatic disease."

    So I've lost a little hope - but not all, not yet, not until after I pay my dues in the MRI machine (at least there are good drugs). My hope is that the previous bone scan showed minimally something that is just now appearing larger - if mets, I hope they're from my previous cancer dx that had some ER+, and maybe I'll have more treatment options. Regardless - if the decision is mets, I hope to get a biopsy.

    Maureen, we have an open MRI here in town, and I had an MRI there before. It was challenging but not impossible (thanks to Ativan and yoga breathing). Mazie, same thing happened to me - I loved the sounds (goose honking, a couple of ducks arguing back and forth), I probably could have fallen asleep. I hope this time is as easy as that last time.

    I'll be back in a couple of weeks, and we'll take it from there, right? Not expending energy on something i cannot change or control right now.

  • lalady1
    lalady1 Member Posts: 618
    edited February 2017

    Hi Nancy - rooting for you in CA! A PET can help show SUV and metabolic uptake more accurately too. Sounds like that is the suspect area re: "new foci of increased uptake in two ribs". Just stay calm until MRI is completed. Ativan and Xanax are our friends. :) If there are rib mets and they are ER+, you might join us with Ibrance or faslodex or both. Come visit our threads as needed. We are here for you!

    (()) Claire

  • ShetlandPony
    ShetlandPony Member Posts: 4,924
    edited February 2017

    Lalady, I'm right there with you. With all this ambiguity, why have they not ordered a PET?CT?

  • NancyHB
    NancyHB Member Posts: 1,512
    edited February 2017

    Great question! My MO mentioned that the bone scan radiologist recommended an MRI. I do t believe we have a PET machine locally but I can easily travel down the road to UM. Given the rate of false-positives with MRIs, would I benefit more from a PET

  • Wildplaces
    Wildplaces Member Posts: 864
    edited February 2017

    my understanding (not an expert just what I have been told) is that a PET/CT is quite comprehensive but will not pick up lesions that are less then 0.5 cm so great overall but not as much detail as an MRI

    From your post strictly speaking you had local recurrence ( so not sure about that CT comment??) not proven metastasis

    I am happy that you are thinking about needing a biopsy if the MRI raises the suspicion of Mets.

    Thank you and you take care too

  • KathyL624
    KathyL624 Member Posts: 217
    edited February 2017

    Nancy, were you highly ER positive the first time? Does that mean your new cancer is definitely a new primary or is it possible some triple negative cells got left behind

  • NancyHB
    NancyHB Member Posts: 1,512
    edited February 2017

    My recent recurrence (last year) was a local recurrence of my initial BC back in 2011. My original BC was 50% ER+ and <10% PR+. UM postulates that my recent TNBC recurrence grew out of some stray cells that were part of the 50% ER- and 90% PR-. My hope is that perhaps there is some ER positivity at work here, which would give me more treatment options. Additionally, sometimes receptors change! So it's always good to check it out.

    I think I'll stick with the MRI. My thought is my MO is looking more for involvement rather than confirmation. But like I said, I won't spend energy on that those things I cannot change. Life is too short not to be fully present in every moment

  • KBeee
    KBeee Member Posts: 5,109
    edited February 2017

    Hoping you get answers soon and that bring some good news. Thinking of you. The wait must be excrutiating.

  • Maureen1
    Maureen1 Member Posts: 614
    edited February 2017

    Take care Nancy, please let us know how the MRI goes:) And us Michigan girls are here if a trip to the Sandhill Crane Winery is in order to enjoy life's moments together - we'll be there with you and for you! Hugs...Maureen

  • robinblessed54
    robinblessed54 Member Posts: 578
    edited February 2017

    Hello ladies, my first time on this thread. I went to see my MO yesterday for my regular check. I told her about the pain in my left hip I have been dealing with for about 3 months. She didn't blink an eye and is ordering a bone scan. I don't have a date yet. It is now bothering me at night waking me up occasionally. I had ILC but no chemo or rads. I am on Femara. She said an interesting thing. I don't see cancer coming back in you. You are such a happy, in control person. I love her to death, but when does one's personality control what cancer does? I am praying that it doesn't show any mets, but glad I am getting opportunity to make sure.

    Robin

  • cliff
    cliff Member Posts: 290
    edited February 2017

    the ct scan uses xrays from several directions around to give a 3d picture. the bone scan uses a radioactive tracer designed to go to growing cells, like cancer, healing breaks, joints of growing people and such while radiating gama rays. then uses a moving gamaray camera to pii9npoint the radiation sources a while after the injection.

  • robinblessed54
    robinblessed54 Member Posts: 578
    edited February 2017

    I have scheduled my bone scan for 3/15. I will keep you all posted.

    Robin


  • NancyHB
    NancyHB Member Posts: 1,512
    edited February 2017

    Good luck with your bone scan, Robin. Please come back and let us know how it goes and what you learn.

    I had my MRI scheduled for Tuesday but the insurance approval didn't come through til Wednesday, so I'm going in this morning. They won't use the open MRI and need me to endure th tube. I'm loading up on Ativan as we speak; this is going to be really hard but I need to be stronger than my anxiety!

    Appointment with my MO is Monday, and I'll have my answers then. Another long weekend of waiting; luckily I have a kitchen that needs painting.

    Funny story: I got the written reports of the bone scan and CT from UM. Both state the reason for scanning as "history of metastatic breast cancer." I actually laughed a little when I read that, it was just such a shock to see it in writing when no one's actually TOLD me that's my dx (and I still have hope). Yet.

  • NancyHB
    NancyHB Member Posts: 1,512
    edited February 2017

    So, I finally have confirmation of bone mets. Two lesions on ribs, one on right side, another on the left. Tomorrow I have a chest CT, next week a brain MRI for staging purposes. My MO doesn't seem concerned that anything has spread past these two areas so our first treatment will be radiation. I guess I'll head over to the bone mets thread and catch up on some reading.

    I made it one year and four days from my recurrent diagnosis. Trying to keep my chin up!

  • Maureen1
    Maureen1 Member Posts: 614
    edited February 2017

    (((Nancy))) so sorry to hear your news....hang in there, sending hugs and positive thoughts as you get your CT and MRI done, getting tests and waiting for results is agony for me. Had a brain and head MRI in January, so thankful my doctor had it read stat so i got the results as soon as i got out of the tube! let us know when you get your results, we're here for you

  • KBeee
    KBeee Member Posts: 5,109
    edited February 2017

    Nancy, I am so sorry to hear that. Hoping all other tests come back clear.

    Robin, I hope your bone scan brings good news.

  • ShetlandPony
    ShetlandPony Member Posts: 4,924
    edited March 2017

    Nancy, we are here for you. I like the idea of zapping those two mets. Exbrnxgrl had her bone met zapped several years ago and is still NED. I like your quote.

    Do let us know, Robin. Keep your mind on other things as much as you can while waiting.

  • robinblessed54
    robinblessed54 Member Posts: 578
    edited March 2017

    Hi ladies,

    Can anyone tell me that has bone mets where your bone pain was. Mine is in my hip/femur. I also have an upper arm pain and pain below my neck right where that bump is on your upper back. Does that sound like something I should worry about? I know, I know, try to not borrow trouble, but as we all know, this is a constant in the back of our minds. My bone scan is March 15. Getting anxious. Thanks for any input.

    Robin


  • robinblessed54
    robinblessed54 Member Posts: 578
    edited March 2017

    Had my bone scan today. Now I wait. They said 5 days. I don't know why it takes so long. They have the radiologist there. What is the next step?

    Thanks, Robin


  • Emily2008
    Emily2008 Member Posts: 605
    edited March 2017

    Robin, did you get your bone scan results today? Hoping it was good news!

  • robinblessed54
    robinblessed54 Member Posts: 578
    edited March 2017

    Emily, yes and arthritis throughout but no mets!! Praise God! I am relieved.

  • QuinnCat
    QuinnCat Member Posts: 3,456
    edited March 2017

    Was watching your posts Robin - congrats. Huge relief for you!!!

  • NancyHB
    NancyHB Member Posts: 1,512
    edited March 2017

    So glad to hear of your good results, Robin!

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