0:00

This is a 76-year-old female with a history

0:04

of right breast cancer back in 1991

0:09

that was treated with lumpectomy that presents

0:12

with a palpable mass.

0:15

The clinician order an FDG PT for staging

0:18

and this is the study that I'm showing you right here.

0:22

You can see on the ME that there's significant abnormality

0:25

in that right chest.

0:28

So the study shows a confluent mass in the

0:33

right breast that has very intensively G uptake.

0:38

I'm gonna change the contrast

0:39

to appreciate the differences in metabolism.

0:44

The SUV max in this mass is

0:49

up to 13.7

0:51

and I just wanna make sure that I include

0:54

all the areas within the dominant mass.

0:58

But as you can see, there's multiple satellite lesions, um,

1:02

that you can appreciate on the CT as well

1:05

that are also FDG avid.

1:08

There's also extension of the disease to the dermis.

1:14

It is noted that there is an asymmetry both in

1:20

FDG uptake but also in the skin thickening

1:23

in the right breast compared to the left raising the concern

1:28

for LGE spread.

1:31

There is multis station analysis in the axi.

1:34

Um, some are seen in independently, uh,

1:37

and some are confluent with the mass

1:40

and they're surgical clips from prior lymphadenectomy.

1:45

In addition to that, we see metastatic disease

1:48

involving the bones.

1:49

Um, here in the right secondary there is a

1:54

expense side lesion that is intensely FDG avid.

1:59

There is also metastatic disease in the lung, uh,

2:03

demonstrated by FDG Avid lung nodules on the left

2:08

and some smaller

2:10

and minimally FDG avid uh, lung nodules.

2:14

Also on the right side scrolling down, we can see

2:19

that there is additional OS CS disease.

2:22

In this case, we see very clearly the area

2:25

of abnormal retrial uptake,

2:26

but it's not so clear on the CT portion

2:30

that there is a disease.

2:31

So this is early detection

2:33

by molecular imaging imaging.

2:36

Similarly, there's a separate focal lesion in the

2:39

left iliac bone that shows, um, mild focal uptake

2:43

but not a specific correlate on the ct.

2:46

So in this case, we diagnose this patient with

2:50

extensive recurrence in the right breast

2:53

with nodal involvement, likely lymphic spread

2:59

In the skin, as well as metastatic disease in the lungs

3:04

and in the bones.

3:06

Some of them are not seen on the ct.

3:10

This patient under one treatment

3:12

and I'm showing the post-treatment PET CT on the top

3:15

and the baseline on the bottom.

3:18

And you can see that there has been a markedly improved

3:22

burden of disease in the right breast.

3:25

And in the right axi, some

3:27

of the metastatic lesions have resolved.

3:30

As you can see, there's no longer uptake in those,

3:34

no nodal in the chest.

3:36

For instance, that left epical

3:39

lung nodule has markedly decreased in size.

3:43

The second breed lesion is much smaller.

3:47

There is more sclerosis

3:49

and there's a decreased tracer uptake.

3:51

And this all goes along with, uh, treatment response.

3:57

Other areas of disease that were seen on prior pit that

4:01

didn't show a CT finding have responded.

4:07

For instance, in this vertebral body where there was a focus

4:10

of uptake, but no CT correlate, now we see

4:14

that the metabolism has resolved

4:16

and a new sclerotic lesion has appeared.

4:21

This should not be interpreted as a new lesion,

4:23

but as a treated lesion.

4:26

As treated lesions become more sclerotic.

4:30

SIM happens with that lesion in the left iliac bone

4:33

where it was only FVG Avid, but clearly defined on the ct.

4:38

And we see that there's a mildly increased sclerosis at in

4:41

that region indicating an additional, uh, site

4:45

of treatment response.

4:47

And as a third example, this OSUs lesion

4:50

that was not very evident on the prior CT

4:54

is now sclerotic and the degree of optic has improved.

4:59

Not completely resolved,

5:01

but this patient shows overall treatment response

5:06

with still some degree of disease present

5:10

in the right breast as demonstrated by persistent

5:15

nodularity with tracer uptake.