Single Sternal Met?

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Tzofeh
Tzofeh Member Posts: 8
edited May 2021 in Stage IV/Metastatic Breast Cancer ONLY

Hello everyone. I need to update my bio because this isn't my first rodeo, unfortunately. I was dx stage 3C in 2012 and then had small skin recurrences for two years, and have been NED since the end of 2014 after elective oopherectomy (High EP+, HER2 neg). I found a small bump in my left armpit that looked like an infected hair follicle to both my onc and primary doc, so they removed it. Lucky me, it was IDC recurrence and they didn't get clean margins. I've been on Arimidex since the beginning of 2015. I just had surgery a week ago to get clear margins (which they achieved, yay, finding a 4mm residual area!). However, the subsequent bone scan and CT showed an apparent single, small sclerotic lesion to the sternum. It wasn't measured, oddly, on the imaging but the radiological onc said it is less than 1 cm. The plan is to do stereotactic radiation (5 rounds).

The radiology onc said he isn't in a big hurry because this is very slow growing due to sclerotic, which he described as laying down extra bone versus bone deterioration.

My question is this: When I have asked for a biopsy my onc and radiology onc both say it can't be done. I don't understand this, and am wondering if this is normal? The radiology onc says 90% it is metastasis based on my history, and I get that, but if there's a 10% chance I don't need radiation again then it may be worth the biopsy. My last bone scan was a year prior and it was negative. There aren't mets anywhere else per the scans.

It was great being NED for so long (over 6 years)!! I thought I had escaped this dreadful disease but here I am again, still Stage IV but no longer NED. Yes, I was previously called Stage IV in 2014 due to small skin mets. Thank you in advance for any that have had sternal mets and have experience with a biopsy or being denied one!

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  • GerdaM
    GerdaM Member Posts: 11
    edited May 2021

    Tzofeh, I don't have sternal mets but was in a similar situation recently when they noticed a lesion in my spine on MRI and planned to radiate it with Cyberknife. I have been NED below the neck since 2017 so giving up my ned status was coning with sk many thoughts and fears. Today we did the planning CT for radiation and after returning home my radiologist called to let me know the lesion isn't metastatic just some sort of degeneration which mimics mets on an mri.

    Why can't they do a biopsy? But anyway - if it's met its okay to radiate it because if not it will initiate some healing processes but I'd prefer Cyberknife if feasable due it's minimal side effects


    good luck to yo

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  • Tzofeh
    Tzofeh Member Posts: 8
    edited May 2021

    Thank you, GerdaM! I would be thrilled if the same thing happens for me, and I am so happy it wasn't spinal mets for you!

    The stereotactic radiation, as explained to me, focuses 100 beams to that exact spot versus 1-2 beams I had for external radiation before in 2012 (33 treatments). He said it's like gamma knife, but to the sternum, with minimal side effects.

    As for the biopsy, I am not sure why they wouldn't want to confirm it before radiation. I asked if they could do it when they did surgery last week to get clear armpit margins as well, and the surgeon said she isn't a thoracic surgeon. The logic doesn't make sense to me, but my medical oncologist and radiation oncologist both acted like a sternal biopsy wasn't done. I've been reading that it is in scientific journals, especially for a single spot. There can be many causes for sclerotic lesions, though mets may be the most likely. I may have to push for a biopsy, so I was hoping others had experienced this.

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  • moth
    moth Member Posts: 4,800
    edited May 2021

    I've read that sternal biopsies can be dangerous because of the proximity to the heart and risk of accidental nicking of the aorta. I'd think it would also depend where on the sternum the met is and whether it's accessible. I know someone else on twitter who has a bunch of bone mets and they're all in places that nobody will touch to biopsy. Frustrating for sure.

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  • exbrnxgrl
    exbrnxgrl Member Posts: 12,424
    edited May 2021

    Yes, some areas of the body are not easily or safely biopsied. I don’t know about the sternum in particular but I do know that a biopsy is not possible in all cases. This is not terribly uncommon and you wouldn’t want a biopsy to pose more of a danger than is considered necessary. Take care

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  • Moderators
    Moderators Member Posts: 25,912
    edited May 2021

    ((((Tzofeh)))) We're sorry you've had to join us (again). You've found a supportive, great group of people here. Have you considered (or already received) a second opinion for this as well? We're all here for you.


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  • Tzofeh
    Tzofeh Member Posts: 8
    edited May 2021

    Thank you everyone! Yes, I actually switched centers to be with one affiliated with MD Anderson. The radiation onc seemed to indicate a biopsy could be done if I really wanted it, but he was concerned it may be "inconclusive" due to the small size (less than 1 cm, exact size not measured).

    I imagine the location places it nearer to my heart and major vessels, so that may be a concern. It's in the sternal body about halfway down to the left. They said the sclerotic area (basically they are seeing new bone/a thickened area thay they say indicates it's very slow growing so that by bone encapsulated it) is inside the bone and not on the surface.

    I go this Friday to see my med onc and rads onc, so I will ask more questions. I was overwhelmed at the last visit, so I forgot half of what was said.I also read that cyberknife is the same as stereotactic, so that is great. There have been some amazing advances in radiation since 2012!

    I am thankful for all of you!!

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