Hello everyone,
I know that a part of this question has been answered in another thread. But I would like to add and ask the following.
Today when I expressed my doubts about getting a viable tissue for mutation testing from bone mets, the onc told me that if there is a tumour in the bone then the testing would be possible. I asked him how we could find out whether there is a tumour, he said the only way we could find out if there is a tumour is to cut the bone and get it biopsied.
I thought that a bone tumour would show up on a pet ct and accordingly it would be cut and sent for biopsy, however he said that even the fact whether there was a tumour or not could be established only after a biopsy.
In this case I wonder why the patient should be cut up when even the existence of a bone tumour is not established.
I also read on Inspire about an oncologist who took out a needle biopsy from a bone met in the ribs and used it to establish NSCLC and two years later this same tissue was used for mutation testing.
If a bone met can yield this much tissue through a CT guided needle biopsy, why should any oncologist insist on cutting a bone out in which it is not known whether a tumour exists or not.
How viable is it to take a needle biopsy from a met in the iliac bone? Would such a procedure not be better than to cut the skin and go through the muscles and nerves to again cut a piece of bone, which might prove not to have a tumour after all and therefore not viable for mutation testing?
Thank you for your patient hearing.
Reply # - September 1, 2012, 06:22 PM
Reply To: Biopsy from Bone Mets
I think you need to ask yourself if a mutation test is needed. would it change his treatment?
Doctors are never 100% sure that anything is cancer unless a biopsy finds it to be cancer; not from pets, ct's nor mri's.
One thing for sure nothing's easy about it.
Reply # - September 1, 2012, 07:46 PM
Reply To: Biopsy from Bone Mets
Thank you Janine. I think doctors are sure this is cancer. They just want to know what is driving it before prescribing a new line of treatment. So this quest is not to find out whether it is cancer but to find out the driving mutation.
We are also keen to find out what is driving this cancer so that the right medicine can be prescribed. If such a targetted medicine will give him even a few months of relief that is our wish. Tarceva can be prescribed without mutation testing, but if it is ALK we need mutation testing, this is why we are keen on a biopsy.
However my question is about the methodology that is being used.
I would like to know the viability of a ct guided needle biopsy from a bone met, if this is viable then I would like to suggest this to the onc. Tissues thus taken will be sent to the US for testing, this will take two weeks, so we have discussed with the onc about prescribing Tarceva during the interim period. I hope such a method will not be detrimental if he has to switch to crizotinib.
Reply # - September 1, 2012, 08:21 PM
Reply To: Biopsy from Bone Mets
I don't foresee that there would be any detrimental effect to switching to crizotinib after Tarceva (erlotinib).
I do agree that it's possible to do mutation testing from bone lesions, but they are less reliable in obtaining results than from some other sources. I believe much depends on the chemicals and duration of decalcification of the bone biopsy before tissue goes for testing.
In terms of getting piece of bone from a CT-guided biopsy vs. an open biopsy, it's certainly possible to try to do the imaging-guided procedure, though it's probably less reliable than an open biopsy, since the needle needs to go into the lesion, and it's hard to know EXACTLY where there is viable cancer vs. an inflammatory or healing response to the metastasis. Having a bigger, open biopsy simply increases the odds of collecting tissue with active cancer.
Dr. West
Reply # - September 2, 2012, 10:37 AM
Reply To: Biopsy from Bone Mets
Thank you so much Dr. West,
Your reply has helped us to agree to bone biopsy. This sample will be sent to Quest lab in the USA.
In the meantime we are planning to start Tarceva.
He lies in bed most of the time these days, so we did not want him to go through this extra stress. But hoping that the surgery will not affect him adversely.
Thank you once again.
Reply # - September 3, 2012, 12:21 AM
Reply To: Biopsy from Bone Mets
Apra:
I have nothing to add here. . .but just wanted to send you and your husband some cyber well-wishes and to let you know that you remian in my thoughts. . .
Laya
Reply # - September 3, 2012, 04:10 AM
Reply To: Biopsy from Bone Mets
Hello Laya,
Good to hear from you. I hope your Mom is responding we'll to treatment. Thank you for your kind thoughts.
An update on my husband. Bone biopsy done today. As the right lung is also affected this time with pleural effusion, plan to do pleural tapping tomorrow and send this fluid for cell block testing. If positive I have requested that this fluid also be sent for EGFR testing and the onc has agreed. So if the bone biopsy is not reliable, we still have the fluid to fall back on. This is the silver lining in a black cloud of progression.
All the best to everyone fighting this scourge.