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How body scans act as an early warning system

Body scans afford people the opportunity to detect early warnings of cancer, cardiac disease and other abnormalities lurking beneath the skin. Typically, the process involves scanning the body with a form of X-ray energy that generates cross-sectional images.

Body scanning technology has come a long way since the first generation of CT scanners emerged in the mid-1980s, says Michael Yeh, director of the UCLA endocrine surgery program and assistant professor of surgery.

“In the present day, we have high-resolution, rapid scanners that are much more comfortable for patients,” he ays. “In my field, I frequently consult with patients who have had an abnormal growth found on a body scan.”

Smart Business spoke with Yeh about the diseases most commonly revealed with scans, how abnormal findings should be handled, and the importance of performing a risk-to-benefit analysis when considering further intervention.

What are some of the various scanning methods?

The various body-scanning methods available are ultrasound, computed tomography (also known as a CT or CAT scan), MRI (magnetic resonance imaging), and the fourth one, typically done for cancer, positron emission tomography or PET. Of those, the one that is most commonly performed is a CT.

What types of diseases are most commonly discovered by scans?

It’s a wide range. The principal body areas of interest are the chest and abdomen. Vascular disease, that is, disorders of the blood vessels, may be found. These include aortic aneurysms, which are abnormally enlarged vessel segments that usually arise in older men, particularly if they have ever used tobacco. Small nodules in the lungs are occasionally discovered. It is quite common to find benign tumors or masses, such as cysts, in the liver and/or kidneys.

My area of specialty is in the endocrine glands of the body: thyroid, parathyroid, adrenal and pancreas. A significant number of findings on body scanning occur in these endocrine glands.

The likelihood of having an abnormal growth on a scan increases with an individual’s age. For instance, approximately 4 percent of body scans performed on people aged 60 years will reveal an abnormal mass in one of the adrenal glands. This is considered a common problem by medical standards.

How helpful are body scans in detecting cancer in its early stages?

Routine body scanning holds the promise of detecting a cancer at an early stage, when it might be more effectively treated. However, one cannot definitively diagnose a cancer on a scan alone. What you need is a tissue diagnosis — that is, usually a biopsy of some kind. In some instances, this can be done with a needle, and in other cases surgery is required.

A scan may detect a neoplasm or tumor. Tumors fall into two categories: benign or malignant (cancerous). Nobody has studied this formally, but the great majority of tumors that are found on body scans are almost certainly benign. This raises a bunch of questions. When an abnormal growth is detected on a scan, we are obligated to investigate the tumor further to determine whether or not an intervention is needed. The questions that a patient will want answered are: Is this a cancer? How will we find out? Does it need to be removed surgically?

How big a part does the physician’s judgment play in interpreting scans?

Most of the scans are interpreted by expert radiologists. When they see an abnormal mass, they alert the primary care physician or the clinician who ordered the scan. Then it’s up to the judgment of the physician, through discourse and dialogue with the patient, to decide what needs to be done next.

I’ll give you a few possible scenarios.
The first is a young, healthy patient with an abnormal finding. In that case, you’re almost always going to be aggressive about making a diagnosis and potentially recommending surgery. That’s because a tumor, if left alone, will have plenty of time to grow and potentially cause problems down the road.

On the other hand, if you’re dealing with an older patient (say greater than 70 years) who has significant chronic illnesses such as heart disease, liver disease or lung disease, then the decision must be weighed carefully. In this second case, it comes down to a risk/benefit analysis because the patient may not tolerate an operation very well.

My job is to go over the ratio of risk to benefit with each patient and only offer patients an operation if I think they stand to gain from it.

MICHAEL YEH is director of the UCLA endocrine surgery program and assistant professor of surgery. Reach him at (310) 206- 0585 or myeh@mednet.ucla.edu. For more information visit www.endocrinesurgery.ucla.edu.





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