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FDG Case: Breast Cancer Staging

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This is a 58-year-old female

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that had an abnormal screening mammogram

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that I'm showing you

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where you can see there's a mass in the right breast

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in the upper outer quadrant.

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And in addition, there are

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prominent lymph nodes in the right axi bilaterally,

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but more worrisome obviously on the right axi since there is

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a right-sided mass.

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On clinical exam, the axi was abnormal and

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therefore the patient underwent an FDG PET TT for staging.

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The dominant mass was biopsied

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and it revealed an ER

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positive air two positive breast cancer

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invasive ductal carcinoma.

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The FG PET CT here that I'm showing you shows, uh,

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extensive disease on the, uh, on the right axi,

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centering ourselves first on the dominant mass.

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We can see that that's the biopsy clip.

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This mass is centrally necrotic

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and as demonstrated by lower FDG uptick in the center.

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Aside from that, there is a separate satellite lesion

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that is slightly outer

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and superiorly with respects to the dominant mass.

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There is extensive nodal disease in the right axi

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and these involved levels one,

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level two, which are posterior

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to the minor pectoral release muscle as well

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as in level three.

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It is important in cases of breast cancer

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to always look at the internal mammaries, you know, add that

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to your search pattern.

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If the GPTT is quite sensitive in the detecting small volume

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of disease, I want you to pay attention

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to the subtle finding that

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if you are only looking at the pity alone, you can see

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that there's an asymmetry

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of uptake in the right in center arm

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malary compared to the left.

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And in this finding, you can also see

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that there is a small lymph node that

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that shouldn't be there.

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And so not only this patient has

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extensive right axillary noal disease,

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but there's also internal mammary disease in the mammogram.

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We saw that there was also some lymph nodes in the left axi,

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which we can see here.

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These are mildly prominent and show low level of epigenetic,

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but they are not particularly suspicious.

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This patient thankfully didn't have any other site

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of disease related to the breast malignancy,

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however, was found to have a focus

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of uptake in the rectosigmoid.

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And for this, I don't have a follow up,

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but when we see this very focal

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and intensely a lesions in the colon, we always recommend

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that colonoscopy

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or a follow up to ensure

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that this is not a separate malignancy.

Report

Faculty

Elisa Franquet Elia, MD

Assistant Professor of Radiology

UMass Chan Medical School

Tags

PET/CT FDG

PET

Oncologic Imaging

Nuclear Medicine

Neoplastic

Diagnosis & Staging

Breast