Unsure - 1293498

Mon, 11/13/2017 - 18:39

So my mom underwent a needle biopsy last Tuesday. She has an appointment tomorrow to get her results. She called me tonight to let me know she had read the biopsy results online. She sure didn't remember much of what she read but did say that it stated it was NSCLC and that they didn't have enough sample to determine anything about metastasis. How can they not get enough when a pathologist is present during the biopsy and examines the samples under a microscope during the procedure?! Will they not be able to stage her cancer because of this issue? She doesn't remember whether it indicated squamos cell or non-squamous cell. I'm sure her doctor will explain a lot at her appointment tomorrow but I'm sitting here feeling just as unsure about everything as I did before she had her biopsy.

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Hi teamfrank,

There's only so much a successful biopsy can tell about one's diagnosis. The best a biopsy can do is to show what a nodule is. All too often a biopsy won't even do that and cause lung collapse. So it sounds like your mom's biopsy was a success. After further testing that takes time to complete the biopsy tissue will tell what specific type of nsclc it is, most likely whether it's squamous or adenocarcinoma and less often large cell.

There are other steps in a cancer workup that will lead to a conclusion about metastases. They are likely to include a PET scan to see if there are other spots likely to be cancer and an MRI of the brain to search for brain mets.

Depending on type of cancer further testing of the biopsy tissue will take place if there treatment can't be of curative intent. If the cancer is adeno there should be an EGFR and ALK mutation test. If neither is found testing for other mutations may be done specifically ROS1. These are the 3 mutations that have specific treatments for those with advanced staged cancer with one of these mutations. If the cancer is squamous testing for PD-L1 over expression will likely be done. Over expression is most often found in squamous and responds well to immunotherapies.

I'm so sorry about your mom's diagnosis and hope she will do well moving forward.

All best,


Hi teamfrank,

Janine posted while I was typing, but here are my (basically identical) thoughts.

The uncertainty you are feeling right now is one of the reasons that many doctors do not make scan or biopsy reports available to patients prior to the appointment at which they will be discussed. Results are difficult to interpret without the context provided by the oncologist. In your mom's case, that's increased by the fact that you're getting the information second-hand from what she remembers. I know that it's tough to wait, especially when you have some bits of information right now, but you need to hear the doctor's explanation and conclusions.

That being said, I'm sorry to hear that apparently your mom has lung cancer. That is the main purpose of a biopsy - to determine whether a mass represents cancer. Beyond that, the pathologist should be able to determine the histology of the cancer - the characteristics of the cancer, in this case non-small cell lung cancer, including whether it is squamous or not. But a biopsy of a single location cannot determine whether the cancer has spread; that is the purpose for a PET scan, which can show other locations in the body suspicious for cancer spread. The amount of tissue collected by a biopsy of a single mass is irrelevant to the question of metastasis; it's only purpose is to test that one mass. If the PET results are available, the doctor will use the results from both the biopsy and PET to determine staging.

A needle biopsy is less invasive than other forms of biopsy, and the size of the sample collected is small. There may be enough tissue available to send a sample for genetic testing, to determine if there are any mutations present, such as EGFR or ALK, that can be targeted with specific drugs, either now or later.

I hope that the appointment will be informative that you will be told that there is no metastatic spread and that curative-intent treatment will be recommended.

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Thank you all for your thoughts. My mom's appointment went fairly well. We still really don't know much more than we did before her appointment though. She has had a PET Scan, that was done prior to the biopsy. She has also had 2 CT Scan (one with contrast and one without). They are going to perform two more tests. The first is an MRI but it is going to be of her breast. She had a nodule that appeared during her mammogram. An ultrasound told the doctors at the time that it was not anything to be concerned about and they told her they would do another test in 6 months to be sure. Well now the oncologist is a bit concerned about that as she has now had cancer show up in two places in her body (lung and colon). That test is tomorrow and she sees a new doctor for those results on Friday. Then on Monday it's back to her oncologist to schedule an appointment for them to do a procedure where they will put her completely out and go in through the lower part of her neck to sample an enlarged lymph node. Once they have the results of that test back they feel they will be able to stage her cancer properly. They told her if either the breast or lymph node shows cancer then she will be considered Stage III lung cancer. She will not be having any surgery but will be undergoing radiation. She was told that if she has Stage III lung cancer then the type of radiation treatment she will need is not something they can do locally and she will be referred elsewhere. Due to her location she believes she will most likely be referred to University of Iowa Hospital. She told me today that she is tired of appointments. I told her that I was sorry to say this but she is going to have a lot of appointments for a while. So, here we are waiting.