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.
Director of the endocrine surgery program,
assistant professor of surgery
UCLA
MICHAEL YEH is director of the UCLA endocrine surgery program and assistant professor of surgery. Reach him at (310) 206-0585 or [email protected]. For more information visit
www.endocrinesurgery.ucla.edu