There was another possible concern raised at the medical case conference, which was ruled out today by a good old fashioned mammogram. (I have decided to call the state of the art positronic emissions mammogram (PEM)  that I am having next Monday, a “fancygram”.

Bear with me, because this is going to require a little background explanation. When I had a biopsy last May, they inserted a tiny titanium clip into the biopsy site. This way, if the site is cancerous there is a marker there that helps the surgeon and radiologist find the site. And if it is benign, the fishy looking but benign clump of cells will be marked for future routine mammograms so you don’t have to keep getting biopsies on the same site.

On the morning of surgery, a radiologist placed a wire in my breast and used ultrasound to make sure she placed the wire according to the location of the clip. However, during surgery, the clip was no longer visible so the surgeon used the wire as a guide. He was not unduly concerned about it but enough to tell us. But then the pathologist didn’t locate the clip either in the excised tissue. Now apparently, these clips can get lost on occasion and it’s not something to get hugely worried about in and of itself. However, someone at the case conference pointed out the possibility, though unlikely, that the tissue that was excised was not the right tissue and it just happened that Dr. Beatty excited tissue with tumors in it. He/she recommended that I have another mammogram to make sure that the clip was out. And by the way, mammography has not had trouble “seeing” metal as opposed to the other imaging problems. Today, I got to see the metal markers that the surgeon placed as well as earlier pictures of the various wires and clips.

The clip is not in there. Hooray!

Well, the girls are going through another round of assessment before surgery. When we last met with Dr. Beatty last Monday, he seemed frustrated with the lack of complete information he’d gotten from my MRI, diagnostic mammogram, and ultrasound. On Tuesday morning, he left me a message sounding mildly excited about a suggestion he’d received at case conference earlier in the morning. Yes, my breasts have been presented at a case conference, which means that my cancer is no longer boring. The case conference was attended by a number of physicians who work with breast cancer, surgeons, radiologists, radiation oncologist, medical oncologists, etc.

I called him back and he told me that one of the recommendations was that I do a positron emissions mammogram (PEM). If this sounds a little like a PET scan, that is not an accident since PET stands for positron emissions tomography. I’m sure my physician would correct me but I’m going to say it’s basically a PET scan of my breasts. The main advantage of this technology is that the clinical trials (it is in stage III clinical trials, which is the last stage by which a drug or technique is tested and if the results are positive, becomes part of standard medical practice), have shown evidence that it is particularly suited to pre-menopausal women, with dense breast tissue, and hormone responsive tumors. Sound like anyone you know?

My understanding is that the other imaging techniques have taken “pictures” of the structure of the tissue and the form of the cells. PEM actually takes a picture of differences in the rate of glucose metabolism (rate by which sugar is broken down and converted to energy) across the breast tissue. Since cancer cells metabolize more quickly than noncancerous cells, they can be “spotted” in the picture because they are shown in a different color (or shade of black/white/gray). This is my understanding and it is somewhat tenuous. My grasp of nuclear medicine and cellular biology are kind of limited.

So they can control my sugar intake during the procedure, I need to follow a strict diet for the 24 hours prior to the procedure-meat, nuts, cheese, butter, peanut butter, and non starchy vegetables. There’s stuff I think would probably be okay like black coffee but it’s not on the forbidden or okay list so I’m not going to chance it. Before the procedure, they will inject me with a solution of glucose and radioactive stuff. Then I sit quietly for an hour. Then they take pictures  And as an extra bonus, I get to sit in a comfy chair for the entire procedure. Huzzah!

I know that one consequence of this is that they might find more stage 1 or stage 0 cancer that they didn’t know about before. My thought is that it is better to know about this so that we can do something about it. Fortunately, the specificity and sensitivity of the PEM is high. That means that the false positive and false negative rates are low while the true positive rate is high. Okay, that was not the clearest explanation about something in my area of expertise–measurement. But I’m in a hurry for another medical appointment so this will have to do for now.

So the big PEM day is next Monday. Wish me luck!