Liver biopsy damage as seen on CT scan?

Greetings:

Bear with me; I need to provide some background before asking my question…

In September 2023, after 8 rounds of neoadjuvant chemotherapy (Folrifinox), I was scheduled for Whipple Surgery to remove a small cancerous tumor in the head of my pancreas. When my surgeon (Dr. Kuntsman at Yale/Smilow) started the surgery with exploratory laparoscopy he found three small lesions on my liver that were quickly biopsied and the frozen sections showed malignancy. Whipple was aborted and I immediately became a Stage IV case.

Follow-up testing of the biopsies post-surgery were inconclusive for cancer due to insufficient sample size. I have had a half dozen CT scans, 2 MRIs, and a PET scan since then and no metastases have been seen. I have always been a CEA and CA 19-9 “non-producer”. Last tests on 7/31/24 were 2.0 for CEA and 9 for CA 19-9.

After another 14 rounds of Folfirinox, in mid-May my oncologist at Yale (Dr. Lacy) paused chemo. All signs were any cancer was “dead” and/or scar tissue. Dr. Kuntsman agreed to re-evaluate me for possible Whipple surgery. He performed exploratory laparoscopy as the first step on 7/1/24. Biopsies of the areas where the original lesions were found, two wedge biopsies of segments 3 and 8 of my liver, and a peritoneal wash all showed no evidence of malignancy. Seemed like a home run at the time! I was re-scheduled for Whipple this coming Tuesday, 8/13 and only had one final check to pass which was a CT scan on 7/29/24 to get a baseline for post-surgery monitoring. And you guessed it…the scan showed two questionable areas on my liver. To quote the scan report:

“New 2 cm hypodense lesion left hepatic lobe on series 4 image 18, in keeping with metastasis. There is also a new perihepatic metastasis abutting the right hepatic lobe anterior segment on series 4 image 19.”

Dr. Kuntsman feels there is the possibility these two “spots” may be damage or inflammation from the ex-lap biopsies on 7/1. As he put it “I took pretty big chunks out of your liver.” But due to the need for great caution, surgery was canceled for Tuesday, I will have another scan (MRI) on 9/4 to see if there is any change, and hopefully he is right and I can still have surgery soon. But I am obviously a little confused and concerned that in spite of all the positive checks and data over the last year, somehow this is new cancer out of seemingly nowhere.

Finally, my question: has anyone else had wedge biopsies that have looked like metastatic activity on a CT scan, but turned out to be biopsy damage? Any other observations or informed opinions to share would be appreciated.

Thanks,
Wayne