Clinical History
41 years old lady recently diagnosed with infiltrative ductal carcinoma associated with ductal carcinoma in-situ of right breast. PET/CT for staging.
Findings
There is a hypermetabolic FDG avid spiculated mass measuring approximately 3.4 x 1.2 x 1.4 cm in the upper outer quadrant of the right breast (SUVmax of 6.4). It does not involve overlying skin or underlying muscles. No FDG avid focus is seen in the left breast.
A few subcentimeter right axillary nodes with low grade avidity are noted (SUVmax of 1.7). No FDG avid internal mammary, left axillary, supraclavicular or mediastinal nodes are present. The ametabolic tiny subcentimeter bilateral axillary, subpectoral, left superior mediastinal and bilateral level II cervical/jugular nodes are more in keeping with reactive nodes.
No FDG-avid focus or suspicious nodule is seen in the lungs. No pleural or pericardial effusion is noted.
There are no FDG-avid intra-abdominal or retroperitoneal nodes. The non FDG-avid subcentimeter paraaortic and bilateral inguinal nodes are more in keeping with reactive nodes.
There is physiological uptake and excretion by the gastrointestinal and genitourinary tracts. No abnormal FDG-avid focus is noted in the liver, spleen, pancreas or adrenal glands. The uterus appears to be slightly bulky. The mildly increased endometrial activity is more likely to be physiological in origin in the reproductive age group. The bilateral non-FDG avid adnexal hypodensities would be consistent with ovarian cysts. Small amount of free fluid is seen in the pouch of Douglas.
The bone marrow shows normal physiological distribution of FDG activity.
Clinical Impression
The FDG avid spiculated right breast mass would be consistent with the biopsy proven right breast malignancy.
The subcentimeter right axillary nodes with low grade avidity are suspicious but not definitive of small volume nodal metastases. Histological correlation is recommended.
No FDG avid metastatic disease is detected elsewhere.
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