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Unexpected Focal Hypermetabolic Activity in the Breast: Significance in Patients Undergoing 18F-FDG PET/CT

Ronald L. Korn1,2, Anne M. Yost3, Christopher C. May2, Eric R. Kovalsky2, Katherine M. Orth1, Tiffany A. Layton1 and Denise Drumm4

1 Department of Research, Scottsdale Medical Imaging, 3501 N Scottsdale Rd., Ste. 130, Scottsdale, AZ 85251.
2 Department of Radiology and Nuclear Medicine, Scottsdale Medical Imaging, Scottsdale, AZ 85251.
3 Arizona College of Osteopathic Medicine, Midwestern University, Glendale, AZ 85308.
4 Center for Law, Science, & Technology, Arizona State University, Tempe, AZ 85287.


Figure 1
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Fig. 1A 72-year-old woman (patient 5 in Table 1) with infiltrating ductal carcinoma being evaluated for Hodgkin's lymphoma. Axial PET image shows focal area of increased metabolism (maximum standardized uptake value = 4.0) in left breast, lateral to midline.

 

Figure 2
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Fig. 1B 72-year-old woman (patient 5 in Table 1) with infiltrating ductal carcinoma being evaluated for Hodgkin's lymphoma. PET/CT fusion image shows hypermetabolic focus corresponds to ill-defined asymmetric soft-tissue density.

 

Figure 3
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Fig. 1C 72-year-old woman (patient 5 in Table 1) with infiltrating ductal carcinoma being evaluated for Hodgkin's lymphoma. MR image shows 2.5-cm lesion (arrow) corresponding to PET/CT abnormality.

 

Figure 4
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Fig. 2A 60-year-old woman (patient 2 in Table 1) with infiltrating ductal carcinoma and ductal carcinoma in situ (DCIS) scanned for evaluation of solitary pulmonary nodule. Axial PET image shows a low level of metabolism (dashed arrow) in right breast with more intense and focal metabolism (solid arrows) in lower outer quadrant of right breast. Maximum standardized uptake value of focal area of hypermetabolic activity is 3.2.

 

Figure 5
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Fig. 2B 60-year-old woman (patient 2 in Table 1) with infiltrating ductal carcinoma and ductal carcinoma in situ (DCIS) scanned for evaluation of solitary pulmonary nodule. PET/CT fusion image shows most intense focus to be associated with ill-defined CT density on lower outer quadrant of right breast in 7-o'clock position.

 

Figure 6
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Fig. 2C 60-year-old woman (patient 2 in Table 1) with infiltrating ductal carcinoma and ductal carcinoma in situ (DCIS) scanned for evaluation of solitary pulmonary nodule. Sonogram shows 1.1-cm area of abnormal shadowing at 7-o'clock position of right breast. Mammogram (not shown) was remarkable for pleomorphic calcifications (BIRADS category 4). Diffuse activity on PET surrounding focal hypermetabolic region corresponded to DCIS. Tumor measured 2.2 cm at time of surgery.

 

Figure 7
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Fig. 3A 71-year-old woman (patient 6 in Table 1) with fibroadenoma who was being evaluated for solitary pulmonary nodule. Axial PET image shows very small focus of hypermetabolic activity in right breast (maximum standardized uptake value = 2.3).

 

Figure 8
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Fig. 3B 71-year-old woman (patient 6 in Table 1) with fibroadenoma who was being evaluated for solitary pulmonary nodule. PET/CT fusion image locates lesion centrally in right breast, superior and lateral to nipple. Biopsy revealed fibroadenoma (images not shown).

 

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