Breast Cancer Case Study 01


Clinical History
53-year-old female noticed a mass in her left breast approximately February 2005 when it was incidentally discovered during plain X-rays for back pain. There was no family history of breast cancer and the patient quit smoking 11 years ago. Mammography revealed a 4 cm x 3.5 cm mass in the left breast and enlarged axillary nodes. Fine needle aspiration cytology (FNAC) of the breast mass showed poorly differentiated infiltrating ductal carcinoma.

Imaging Findings
NUCLEAR MEDICINE PET/CT: 5/19/05
STATED REASON FOR REQUEST: Staging breast cancer

PET/CT FINDINGS: The initial staging PET/CT scan revealed hypermetabolic foci in the left breast that were consistent with the known malignancy.

In addition, there were multiple intense hypermetabolic foci in the left axilla, compatible with metastatic lymphadenopathy, and multiple hypermetabolic foci involving the bony skeleton, suspicious for osseous metastases.

Treatment
The patient opted for breast conservation, denied surgery and wanted to avoid chemotherapy. She was given hormonal treatment only.

Follow-Up Scan Imaging Findings
NUCLEAR MEDICINE PET/CT: 6/01/08
STATED REASON FOR REQUEST: Restaging breast cancer
COMPARISON: Follow-up CT of the thorax, abdomen and pelvis in January 2008 which revealed progression of the metastatic disease

FOLLOW-UP PET/CT FINDINGS: A follow-up restaging PET/CT scan performed in June 2008 was compared to the thoracic and abdominal CT study performed in January 2008.

There was worsening mesenteric and peripancreatic adenopathy when compared to the CT scan of January 2008. The bony metastatic disease within the chest, abdomen and pelvis was unchanged from January 2008, but there were multiple additional bony metastases which had spread throughout the skeletal system. There was focal uptake within the distal descending colon which correlated with a possible hyperdense focus noticeable on CT. This was suspicious for metastatic disease or primary colon neoplasm rather than physiologic activity. A colonoscopy was recommended for further evaluation.

Treatment
In view of the progressive metastatic disease, palliative radiotherapy was advised with a focus on reducing bone pain. The patient agreed to start chemotherapy along with continuing the hormone therapy.

Data courtesy of Dr. David Townsend, University of Tennessee Medical Center, Knoxville, TN, USA

* Any of the protocols presented herein are for informational purposes and are not meant to substitute for clinician judgment in how best to use any medical devices. It is the clinician that makes all diagnostic determinations based upon education, learning and experience.