Confused by MRI results after treatment for triple negative breast cancer

[Arthurnewyorkcity]

Hi hoping someone may have some experience of this.

I have tnbc breast cancer. I had a midway ultrasound which showed 'excellent response' and benign fibro (something) change. Although tumour could be felt by hand, it couldnt be measured on ultrasound.

Cut to end of treatment mri. Tumour is same size and they cant tell it its cancer or scarring.. surely they must have some idea. I get pathology post surgery will confirm but this just seems odd to have had such a good midway and now im really worried its not worked at all

Thank you

So it sounds like you had a good response to treatment and then since that scan (3 months ago?), the tumour has remained the same size. This is generally not considered a bad thing. It means stable disease or it’s just dead tissue. Unless they see progression, they consider it good.

So I don’t have breast cancer, but between month 0 and 3, my tumours actually grew. This is normal ish for my cancer (melanoma) and treatment. Between months 3 and 6, they shrank. 3 of them are completely gone and one is about the size of a small marble, but it was like golf ball sized 3 months ago. I don’t know that it will shrink or ever go away completely, though my treatment is 2 years in total so I still have another 18 months to go, so maybe? But they consider this good. It’s there but not getting bigger.

They may consider doing a PET scan. This usually gives a better idea of its active disease or necrotic tissue. It’s harder to see by MRI or CT. But they may want to watch and wait rather than expose you to the added risk of a PET. You could ask though and see what they say?

MRI is usually more sensitive than ultrasound. My breast cancer was missed initially on ultrasound but picked up on MRI. However that also means the MRI will pick up other subtle changes like scarring which can mimic cancer. I hope the pathology results bring positive news.

TNBC survivor here. I didn’t have a midway scan or an MRI but at the end of chemo my lump was there but dead. One of my lymph nodes was still large but by surgery 9 weeks later it had shrivelled almost to nothing. I got PCR. I’m three plus years on from diagnostic s and doing well. Please don’t worry too much, surgery will give you a definitive answer.

@mindutopia its reassuring that anything not progression is good and im glad to hear youve had some positive results already. How are you feeling? I am also having immunotherapy.

@Restlessdreams1994 same here! How are you now? I understand why they cant give a definite answer but surely they must be able to tell roughly if it looks more scare like or cancer like.

@FriendlyGreenAlien so nice to hear youre doing so well 3 years later. Long may it continue. I am really hoping for pcr. Were you on the keynote protocol?

Often they will just rescan to check and if it doesn’t “do” anything it will be assumed to be dead tissue or scarring. But a PET scan would give a definitive answer. Is expensive and higher risk though. It’s not unusual what you’ve experienced. All the best with the rest of your treatment. 💐

I was. Tumour was big enough and I had local progression into lymph nodes so I had immunotherapy with chemo and again after radiotherapy.

@FriendlyGreenAlien how long did you have chemo for after surgery? Was it tablet form? Its so nice to hear some positive stories. If dont mind me asking, what does check ups look like now? Do you have annual mammogram?

Hi, I have tnbc. I’ve had chemo surgery radio and due to finish chemo shortly, I am just having a few post radio complications.

i had a scan post chemo pre surgery to see what they could see, couldn’t find anything on breasts but could still see enlarged lypmh nodes (big) and hadn’t reduced much in size. Oncoplastic surgeon gave me the statistics of having a full total response in breasts but no response in lymph nodes and said it would be very rare but it could happen and said it was more than likely due to damaged scare tissue from the chemo, but they wouldn’t no unless they remove fit.

they suggested total lymph node clearance due to a number of reasons, one I was a genetic carrier and risk of returning was super high, two, I had done all of this and gone through all this and removing the LN would reduce risk of returning greatfly and it seemed sensible for me to just remove this last puzzle piece since I was getting a double masc (with recon). So, please don’t fret, it really can be scaring but they won’t know unless they biopsy.

i hope that’s clear I’m trying to be concise but if you’ve got questions or I’ve missed something happy to answer if I can.

@Bangersndmash thank you so much for replying. How are you now? Im not sure I've read this correctly, but the consultant thought it was unlucky the lymph nodes would be pcr at biopsy? Is that right? I am so confused how my midway was 'we cant measure' to 'not sure if cancer or not'. To go through 16 rounds of chemotherapy and its still there is so worrying. Did you have immunotherapy?

Unlikely* I meant

My scan post chemo pre surgery showed a total response from chemo, no visible cancer found in scan on breasts, but there were calcifications in lymph nodes. He gave the statistics of it likely being scarring were very high, but they couldn’t be certain until the removal and biopsy.

it was just scaring, I had a full total response to chemo from my tnbc, I’ve had the full works as the usual routine palci carbo EC immuno the job lot.

did you say the breast scan was clear but lymph nodes unsure or breast scan unsure? It is hard to tell purely from scan but given I had a full response in breast it was v v unlucky to not have response in LN.

Sorry just re read your post for clarity. They really can’t say until the biopsy but I’m confused … they said It shrank and couldn’t be measured but now it’s gone big again in the scan; is that what you’re saying?

I had the same, followed by a mastectomy that showed that it was all dead tissue. I know it’s hard not to worry, but you wont know anything for sure until you’ve had your surgery. X

Sorry im probably not explaining particularly well.
Midway through treatment when I was on the carbo/pax and immunotherapy, I had an ultrasound scan. At this time the lump could be felt with hands.. but was not measurable under the scan as it appeared to benign changes. Roll on end of treatment scan which was an mri and im told they cannot tell if scarring or cancer. I can still feel a lump.

My first mri (pre treatment) showed it at 3.7cm, and now its 2.7cm.

@Bellabelloo so pleased for you!

Ok so that’s all good news, you’ve had chemo, and it’s shrank. I had a mid way scan and it still showed some in breast and then I had a final scan which showed nothing visible in breast. So the good news is; it’s responding to treatment well.

As they have said, they really can’t tell if it’s scarring or not until the biopsy, but in my case it was indeed extreme scarring from the chemo. So fingers crossed for you it will be just as good news but it all sounds positive.

but I appreciate it’s all easier said than done to try and wait. When is your surgery booked in for, what are you having and when did you say your genetic testing is back, do they know?

@Bangersndmash thank you so much. I pray its all scarring. Surgery is November 2nd. Plan was originally a lumpectomy but I have very small breasts so I guess depends if they still can. I meet with the surgeon thurs to discuss. I know everyone is different but seems odd how some people's tumours completely disappear and others change to scarring? Be glad to have it out. How did you find surgery recovery?

Well I’ve had a double masc with DEIP flap recon; recovery has been a little long but got there in the end. It’s funny because it’s not one size fits all, I finished my chemo in May and I’ve sadly been in hospital the past week due to now just having post chemo complications arise NOW. But in terms of the cancer, that’s gone and I’ve kicked that ass so one thing ticked off the list. It’s amazing what the treatment can do.

i found my genetic testing influenced my surgery greatly. Hopefully your recovery and surgery is easy on you, lumpectomy is easier I’ve heard.