Breast Cancer Case Study 02


Clinical History
50-year-old female, with history of breast cancer status post lumpectomy, chemotherapy. Patient presented with recurrence with positive biopsy of a supraclavicular lymph node, but no other disease noted on CT alone. The patient was referred for a PET/CT evaluation before radiation therapy.

Imaging Findings
NUCLEAR MEDICINE PET/CT
STATED REASON FOR REQUEST: Restaging prior to radiation therapy
TECHNIQUE: Emission scanning from the neck through the pelvis was obtained approximately one hour post injection. Images were reconstructed with and without attenuation correction using the CT attenuation coefficients from the corresponding CT portion of the exam. The patient's blood glucose measured 103 mg/dL.

PET/CT FINDINGS: The PET/CT study showed a focal area of intense radiopharmaceutical uptake just posterior to the brachiocephalic vein consistent with a metastatic lesion. There was also an intense area of uptake in the right iliac crest.

Treatment
Treatment was ultimately changed from local radiation to the supraclavicular area to systemic chemotherapy.

Discussion
This case is a good example of the added benefits of PET/CT. First, the patient had a subtle abnormality detected posterior to the brachiocephalic vein that was barely visible on CT, but was certainly very compelling on the fused PET/CT image. Secondly, the patient had a large lesion in the right iliac crest that was not visible on the CT portion of the exam. The PET images revealed increased radiopharmaceutical uptake, but upon further investigation the CT images showed no bony destruction. The PET/CT images localized the increased radiopharmaceutical uptake to the right iliac crest.

Data courtesy of Dr. Todd Blodgett, University of Pittsburgh Medical Center, Pittsburgh, PA, 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.