Breast Cancer - A 39 year old woman with history of breast carcinoma

Clinical History
A 39 year old woman with history of breast carcinoma treated with left mastectomy and tamoxifen therapy in 2003, presented with enlarged neck nodes suspicious for metastases. The patient was referred for FDG PET•CT which was performed in September 2006.

Imaging Findings

Imaging Findings PET•CTScan 9/12/2006: The FDG PET•CTstudy showed extensive FDG avid supraclavicular and mediastinal lymph node metastases involving bilateral hilar nodes as well as anterior mediastinal and prevascular nodes. Metabolically active celiac node metastases were also visualized. There were multiple metastatic lung nodules in both lobes (Fig. 1). Based on the PET•CTfindings the patient was classified as stage IV breast cancer and was put on Herceptin® chemotherapy and tamoxifen was continued. The patient was referred for a follow-up FDG PET•CTscan to evaluate therapeutic response in January 2007.

Imaging Findings PET•CTScan 1/3/2007: The follow-up FDG PET•CTstudy performed in January 2007 showed complete resolution of previously metabolically active supraclavicular and mediastinal and portocaval lymphadenopathy. The metabolically active lung parenchymal nodules also show partial resolution of activity suggesting positive therapeutic response.

Discussion
This study shows the value of PET in correctly staging the patient and guiding appropriate therapy as well as acting as an indicator of therapeutic response. Low FDG uptake in diffuse lung opacities seen in the CT scan was the guiding factor in differentiating metastatic disease from a chronic infection like MAI.

Data courtesy of Dr. Charles Intenzo and Dr. Sung Kim, Jefferson Center City Imaging, Philadelphia, PA

* 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.