Tattoos Mistaken as Cancer Metastases, Surgery Performed

“Physicians should be aware that tattoo ink can look like the spread of cancer to the lymph nodes on diagnostic imaging — and unnecessary treatment can result.

“That is the take-home message from a case report of a 32-year-old woman with locally advanced cervical cancer.

“The 14 tattoos that extensively covered the legs of the mother of four had been applied over an 11-year period. Images included a black panther, the phrase ‘I’ve got baggage’ (with the image of a suitcase), and the title of a children’s show, Yo Gabba Gabba. The most recent tattoo had been applied 2 years before her presentation.

“As in many cases of locally advanced cervical cancer, imaging was performed before surgery to look for metastatic disease, according to Narine Grove, MD, and colleagues from the University of California, Irvine.”


Super Patient: Genetic Testing Gives Lisa Goldman a Targeted Treatment for Lung Cancer


In October 2013, Lisa Goldman had a dry cough that wouldn’t go away. “It was bad enough that I went to the doctor, which I don’t do very often,” she says. He ordered a chest radiograph, said her lungs were clear, prescribed codeine cough syrup, and sent her home.

But she kept coughing, so she kept coming back. On her second visit, her doctor said her airways were irritated and prescribed an inhaler and antibiotics. By her third visit, she’d begun to cough up a bit of blood, but her doctor just repeated that her airways were irritated and prescribed steroids. Continue reading…


Breast Biopsies Leave Room for Doubt, Study Finds

“Breast biopsies are good at telling the difference between healthy tissue and cancer, but less reliable for identifying more subtle abnormalities, a new study finds.

“Because of the uncertainty, women whose results fall into the gray zone between normal and malignant — with diagnoses like ‘atypia’ or ‘ductal carcinoma in situ’ — should seek second opinions on their biopsies, researchers say. Misinterpretation can lead women to have surgery and other treatments they do not need, or to miss out on treatments they do need.

“The new findings, reported Tuesday in JAMA, challenge the common belief that a biopsy is the gold standard and will resolve any questions that might arise from an unclear mammogram or ultrasound.”


FDG-PET/CT Shows Promise for Breast Cancer Patients Younger than 40

“Researchers at Memorial Sloan Kettering found that PET/CT imaging of patients younger than 40 who were initially diagnosed with stage I–III breast cancer resulted in change of diagnosis. As reported in the October issue of The Journal of Nuclear Medicine, while guidelines recommend FDG-PET/CT imaging only for women with stage III breast cancer, it can also help physicians more accurately diagnose young breast cancer patients initially diagnosed with earlier stages of the disease.

“Assessing if and how far breast cancer has spread throughout the body is what doctor’s refer to as staging. Most women nowadays are diagnosed at earlier stages, meaning stage 1 or 2 of possible 4 stages (stated Christopher Riedl, MD). Current National Comprehensive Cancer Network (NCCN) guidelines consider systemic FDG-PET/CT staging for only stage III breast cancer patients. More recently it has been debated whether factors other than stage should be considered in this decision. One such factor is patient age, as young breast cancer patients often have more aggressive tumors. In this study, a team of researchers from Memorial Sloan Kettering Cancer Center in New York evaluated for the first time the impact of FDG PET/CT staging specifically in a young patient cohort. The study suggests that breast cancer patients under the age of 40 may benefit from systemic staging with FDG PET/CT at earlier stages than NCCN guidelines suggest.

” ‘Proper staging right after the breast cancer has first been diagnosed will help doctors make the right treatment decisions. And figuring out which breast cancer patients will benefit most from this “advanced staging” with FDG PET/CT helps us to improve patient care while avoiding unnecessary tests,’ stated Christopher Riedl, MD, one of the team’s lead researchers. ‘Our data suggest that women younger than 40 may benefit from PET/CT staging at earlier stages than doctors previously believed.’ “


Lung Cancer Test Less Effective in Areas Where Infectious Lung Disease is More Common

“A new analysis of published studies found that FDG-PET technology is less accurate in diagnosing lung cancer versus benign disease in regions where infections like histoplasmosis or tuberculosis are common. Misdiagnosis of lung lesions suspicious for cancer could lead to unnecessary tests and surgeries for patients, with additional potential complications and mortality.

“Histoplasmosis and other fungal diseases are linked to fungi that are often concentrated in bird droppings and are found in soils.

“The study by investigators at Vanderbilt University and the Tennessee Valley Healthcare System-Veterans Affairs was led by Vanderbilt first author Stephen Deppen, Ph.D., and principal investigator Eric Grogan, M.D., MPH, and appeared in the Sept. 24 issue of JAMA.

“Positron emission tomography (PET) combined with fludeoxyglucose F18 (FDG) is currently recommended for the noninvasive diagnosis of lung nodules suspicious for lung cancer. To estimate FDG-PET diagnostic accuracy, the authors reviewed lung cancer abstracts published in a 14 year period and included 70 studies in the meta-analysis. The studies included 8,511 nodules, 60 percent of which were malignant.”


Improved Diagnostic Performance of Low-Dose Computed Tomography Screening

“Investigators of the COSMOS (Continuous Observation of SMOking Subjects) study show good compliance and patient survival outcomes using a 5-year low-dose computed tomography (LDCT) screening protocol in individuals at high-risk of developing lung cancer. This protocol had fewer patients requiring further diagnostic follow-up compared to other studies, including the National Lung Cancer Screening Trial (NLST), with a minimal number of incorrect diagnoses.”