Case of the Month—December 2004
Metastatic Breast Cancer
—Response to Chemotherapy
History
The patient is a 55-year-old female with a history of breast cancer. She had left breast lumpectomy in May 2003, followed by chemo and radiation therapy. In April 2004, the patient developed right pleural effusion and was found to have a 1.5-cm pulmonary nodule in the right lower lobe of the lung. The patient then underwent wedge resection of the right lower lobe nodule and segmental pleurectomy. The right lower lobe pulmonary nodule was proven to be benign. The pleura specimen revealed chronic pleuritis. The CT of the chest, abdomen, and pelvis performed after the surgery revealed only pleura thickening, without evidence of metastasis. A PET scan was requested a few days after CT scan to rule out metastasis and for re-staging the patient.
PET Finding
The PET study showed a focal uptake of FDG in the left breast at about 3 o’clock position consistent with recurrent cancer (Figure 1). In addition there are multiple foci of increased uptake in the left axilla, consistent with metastasis. There is curvilinear uptake involving the right lower lateral pleura that is likely due to post-surgical changes.
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Figure 1. Pre-chemotherapy.
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Follow-Up
After PET scan, the referring physician found a small skin nodule in the left breast. An excisional biopsy confirmed metastasis from prior breast cancer. Chemotherapy was then started. Two months later, a repeat PET was requested to assess the early response of chemotherapy (Figure 2). The second PET scan revealed interval resolution of abnormalities, indicating good response to the therapy.
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Figure 2. Post-chemotherapy.
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How Did PET Help?
PET detected early metastasis that had not been detected by CT. Furthermore, PET was very useful for evaluation of early response to chemotherapy.
Discussion
PET is a very useful tool for detecting recurrent breast cancer and distant metastasis. Moreover, PET is more accurate than conventional imaging studies for re-staging the patient and monitoring response to therapy.
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