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Can progression on PET CT scan be scar tissue and not Cancer?
My mom was diagnosed with Metastatic Breast Cancer in December 2022. Her tumors were ER+ and HER2+. She underwent 18 cycles of Paclitaxel, Trastuzumab every 3 weeks and Zoledronic acid every 4 weeks. She was on Letrozole 2.5 mg every day.
Her scans were stable till November 2023. In February 2024 her scans revealed progression in her bones.
Below were the findings from her PET CT scan.
1. Increased FDG uptake is noted in the marrow and lytic-sclerotic lesions involving multiple bones of axial and appendicular skeleton.
2. Increase in number and metabolic activity of the skeletal lesions.
3. No significant interval change in the primary breast lesion and axillary nodes.
4. Decrease in size of the non FDG avid splenic lesions.
5. No metabolically active disease elsewhere in the body.
Her oncologist wants to change her treatment line and he has given us 2 options.
1. TDM1
2. Oral pill + Trastuzumab
He also asked us to shift to Denosumab from Zoledronic Acid.
My question was could the progression on her PET CT scan be scar tissue and not cancer?
The oncologist did not look at the film, just checked the report and wanted to change the treatment line.
I am very worried and require help from expert members in the group.
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@allwync88 sadly none of us are doctors, we are patients like your mom. That being said I can try and translate a little. Lytic lesions are where the cancer causes a hole in the bone. My husband has this type of lesions in his bones so I am familiar. Your oncologist probably just read the read the report because the radiologist is the expert at reading the scans and they write a report for your doctor.
I have received quite a few of these reports over the years and it sounds like they found a change in your moms cancer pretty early, and are changing the drugs since the old ones are not being as effective anymore.
I cannot really give you any more information about it, since all I can really do it translate what you told me a bit. I know how scary this is, I hope it helps.
How are you feeling about all of this, how is your mom feeling? Has she started the new regimen yet?
Thank you for replying to me.
I do not feel good. Mom has not taken it well. She took Lapatinib (5 tablets) and Capacetabine (4 tablets) yesterday and was sleeping most of the time.
The only thing I wish is that there is a cure for this terrible disease and everyone gets saved.
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4 ReactionsAlthough I too am not an MD, I am a PET / nuclear medicine technologist. I have done PET/CT for years and although CANNOT give you medical advice, I can explain how the scan works and that may help you.
Simply put; CT measures (images) densities. Benign or malignant the same. PET images are based on metabolic activity. Or how it consumes the injection. Scar tissue has very little if any metabolic activity. Ergo it is not alive. Malignant tumors are highly metabolically active (alive) and consume the glucose (sugar) in the FDG F18. This is the compound FluoroDeoxyGlugose attached to the isotope Fluorine 18. F18 is a positron emitting isotope that is ejected from the nucleus and strikes an orbiting electron creating “pair production” which is two 511 KeV photons at exactly 180 degrees from each other. This consistency makes imaging predictable and reliable. (Sorry to bore you with the technical stuff). Bottom line, theoretically, only metabolically active molecules will light up with enough activity to be rated in SUV’s. (Standard Uptake Values.) the higher the consumption rate the higher the SUV. There are some exceptions; infection being just one of them. In everything, there is variation, thus the activity needs to be quantified to show the relative value (chance) of active malignancy.
These complications are what make it important for a Radiologist (MD) trained in PET to be reading these.
Hope this helps.
Remember, I am NOT an MD. I am NOT offering/giving medical advice. I in NO way am indicating what your scan means literally or implied. Consult your physician for medical advice please.
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4 ReactionsI am so sorry about your mom.
I too am not a doctor, and please talk to docs.
My first Pet/CT when I was Stage 3 and we needed to see if it was Stage 4 had a couple of iffy spots that were not the disease progressing.
I had one spot inflamed where my epidural had been (I'd just had a baby, and probably the site was infected still a bit), and one tiny spot that was not listed anything like what your mom's report is.
I am sorry about the report, and I hope your mom's team can clarify everything.
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1 ReactionI had 2 mammograms and 2 sonograms both said scar tissue . Hospital did biopsy said was breast cancer was in the same exact spot where I had gotten bitten and scratched by a cat . Hospital said was cancer so had surgery in Jan said it was cancer when I met with surgeon 10 days later he said he had to go back in as he did not get it all. He did surgery right away but said was not cancer was scar tissue. I think it is very strange that the cancer was located in same spot as cat bit (scar tissue) I am scared now to get mammogram that it might be scar tissue mistaken for cancer. Does anyone know what I can do is there a special mammogram or MRI I should ask for?