Breast Cancer - 50 year old female

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

Dosage
15mCi F-18 FDG by IV

PET/CT Findings
Focal lesion posterior to the brachiocephalic vein consistent with metastatic disease.

Intense area of focal uptake in the left iliac crest without an identifiable CT correlate. Findings are still consistent with metastatic disease.

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 is barely visible on CT, but is certainly very compelling on the fused PET/CT image. Secondly, the patient has a large lesion in the right iliac crest that is not visible on the CT portion of the exam. It is not uncommon to find a lesion on PET, localize it to bone using PET/CT, but realize there is no bony destruction yet.

Change in treatment plan
Treatment was ultimately changed from local radiation to the supraclavical area to systemic chemotherapy.

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