Expert: Claes-Gustaf Nordquist, M.D. - 3/20/2007

Question
QUESTION: I have a 40 year old friend who had a full mastectomy plus chemo 7 years ago. I am not sure of the cell type. Recently a CT was interpreted to show the cancer has spread to her lungs. The radiologist seems to be very sure. Here in this city in China, they will begin chemo just based on the CT, without doing a biopsy. Can you be so sure from the CT pic alone.

My friend is not having any symptoms, although she did have a lung CT 6 months ago that caused some concern. She went for this CT because of a cough that would not clear. She was just told to watch it. This most recent CT compared to the one 6 months ago indicates the problem has progressed. Even so, don't you need to do a biopsy?

Thank you.
ANSWER: The CT pictures may be highly suspicious for mestastatic cancer spread. I would prefer a biopsy too!

---------- FOLLOW-UP ----------

QUESTION: I'm sorry Dr. Nordquist, I don't quite follow the meaning of your first sentence. Are you saying that based on her history and what's going on in the lung CT pictures, it is quite likely to be metastasis. Or, that it is quite suspicious to rely on the CT scans alone to diagnose this.

Thanks again.

ANSWER: Sorry that I have not been clear enough. I meant that it is likely that her cancer has spread but that I would like to have it confirmed by a biopsy (or several).


---------- FOLLOW-UP ----------

QUESTION: I definitely will advise my friend to go Beijing and find a more thorough caregiver and get a biopsy before formulating a treatment approach.

Since hers is very probable a metastasis to the lungs, what do you think are the chances that her (experienced) radiologist would make a mistake in interpreting her lung CT, and that it would actually be some lung infection that has not cleared up? How different are these two conditions on a CT pic?

Why preferably more than one biopsy of the lung?

Answer
A mistake is unfortunately not very probable. Well if there are several lesions, more biopsies may be needed.
Any biopsy there would probably have to be done as a thin needle aspiration biopsy (you can check what that is on Google). I do not know to what extent that is available in China.