What does the PET-CT show?

Medicine of course over the years has become increasingly technical. Imaging in particular has replaced, in my opinion, much of the art of medicine and replaced it with science.  With advanced imaging techniques old questions get replaced with new ones.

I appreciate this phenomenon on a weekly basis during tumor boards.  Specialists from medical oncology, radiation oncology, surgery, radiology and pathology convene on a conference room with a list of patients to discuss how particular patients with cancer should be managed.  With all the advanced electronic medical record keeping, communications devices and collegial nature of treatment teams, it still pays to get together face-to-face, present cases, review the radiology and pathology and try to get a consensus on best management on a patient-by-patient, or as we sometimes unfortunately refer to them, on a case-by-case basis.

Inevitably, after a patient’s clinical presentation, symptoms, radiographic findings, biopsy, and in some cases, surgical course and surgical pathology findings are discussed the next question that comes up is “What does the PET-CT show?”

The PET-CT allows physicians to detect metastatic disease that may alter the course of therapy.  If the PET-CT, for example, is negative in a patient with clinicopathologic low-stage disease, one algorithm is followed, if however, PET-CT shows evidence of metastatic disease, another algorithm will have to be followed.  This is where science trumps the art of clinical medicine.  A complete lymph node examination, neurologic examination or thorough abdominal examination may provide clues as to other organ involvement but what those don’t detect or not discovered with, the PET-CT will show literally like night and day.  “Hot spots” of uptake will provide clues as to whether a tumor has metastasized.

Of course no test is 100% sensitive or specific and radiology or nuclear radiology is no exception, so occasionally findings on PET-CT provide other questions to replace the old ones.  “Do we need to biopsy that ‘hot spot’?” Or “Is that really metastatic disease?”

New technologies always seem to provide new solutions and answer old questions while presenting new challenges and questions of their own.

Digital pathology will no doubt provide new answers, allow us to dig deeper to help patients and solve problems that limited us before while creating new challenges to address until the successor technology answers the new questions and the cycle will continue.

Much like the PET-CT, digital pathology new tools to help patients in ways thought unimaginable a few years ago.  It will not replace the need for tried and true clinical business practices but it will allow pathologists, our oncology colleagues and patients the wonder of answering questions before unanswerable and allowing us the challenge to answer new questions.