Can Sonogram § Petscan replaces Biopsy

[gerrie]

In Jan. 2002 my mammogram read calcification in both breasts.  The right breast had about 15 specs, which the surgeon said was unusually high, since my previous 2 taken a year apart each, showed no calcification.  I had breast cancer in 1999 and had a lumpectomy performed on the left breast.  His recommendation is biopsies in both breasts.  Are there less invasive ways to tell if I have cancer again?  Would a sonogram or petscan be advisable.  If so, what can be learned from them that cannot be learned from a mammogram.  My surgeon does not recommend a core biopsy, because he feels they are not that accurate and can miss the site where the cancer might be. Is this true? Previous to this I have had 4 biopsies done on my breasts and this would make the 5th and 6th.  I have been thinking of just having a mastectomy and skipping the biopsies, because going through all these procedures is getting to be more than I can mentally handle.  I understand from the surgeon that he does not think the insurance would cover mastectomy without doing the biopsies first to see if it is cancer again, and I don't know if this is true.  My insurance says he would have to submit his findings before they would agree to pay for this procedure. It is hard to sort out what is true, especially when the surgeon is going to be paid for 2 procedures and may have a personal agenda here. Thanks in advance for your information on this subject.

[CCF-RN,MSN-JS]

Dear gerrie, Microcalcifications are small calcium deposits found within the breast tissue.  There are different types of microcalcifications, and based on their pattern on the mammogram it gives the radiologist clues as to their cause.  For instance microcalcifications that are more scattered are probably due to a benign (non-cancerous) cause, a “cluster” of microcalcifications may increase concern that there may be an underlying tumor.  If the microcalcification pattern is indeterminate the radiologist would usually recommend a more focused mammogram (diagnostic) which would include magnified views to the area.

A sonogram would be used to differentiate between solid and fluid filled areas.  A PET scan is used more to look for areas of increased uptake of dye that would indicate the increased metabolism of cancer, however there are limits to what this scan can do.  For example, a very small area may not show up on this scan.  Neither of these tests are used in place of a biopsy for a definitive diagnosis of cancer.

Regarding the insurance issues regarding coverage of procedures, you would have to go by what your insurance company requires(different companies and different insurance plans have varying procedures and requirements)  If they require prior authorization and information from the physician in order to authorize coverage then you need to get that information.

Most insurance companies do cover second opinions and this might be something to consider.  Having a breast specialist review the findings and make a recommendation which may help you in sorting this all out.

[Binkie]

Gerrie, I cannot answer most of your questions. But if mental anguish is one of your main concerns , having mastectomies isn't the way to stop that because, after a mastectomy, doctors want to do radiation and/or chemo. Ask him or get a 2nd and 3rd opinion.
I've been reading about thermography; you could research that on google.com. Best Wishes, Binkie