(GE Medical Systems, Discovery 690 140 kVp, 18 mA, 3.75 mm slice thickness. The standardized uptake values (SUVs) are normalized to the patient’s body weight and indicate the highest activity concentration (SUVmax) in a given disease site. The low-dose CT was with oral contrast, but without intravenous contrast and was used for image fusion, attenuation correction, and lesion localization only. The patient’s fasting blood glucose measured just before intravenous injection was 75 mg/dL. (a) Maximum intensity projection (MIP) and (b) Fused axial plane images through the upper chest approximately 67 minutes following intravenous injection of 12.268 mCi of 18F-2-fluoro-2-deoxyglucose (F18-FDG) through the patient’s right antecubital vein. Technique: Positron emission tomography-computed tomography (PET/CT) from the skull to the mid-thigh level. No evidence of regional or distant metastases. PET/CT demonstrated a hypermetabolic focus within the right breast corresponding to the patient’s known malignancy, however was negative for evidence of regional or distant metastases ( Figure 5).įindings: There is a hypermetabolic focus within the right breast with maximum standardized uptake value (SUVmax) of 13.7 (arrows), corresponding to the patient’s known primary malignancy. Clinical stage was difficult to determine due to the large cystic component of the tumor, but was favored to be T2 versus T3, N0 clinically. It is hypothesized that a cancer developed adjacent to the cyst, invaded the cyst wall and hemorrhaged into the cyst, expanding it. Tumor markers demonstrated a high proliferation index for Ki-67 (greater than 50% invasive tumor nuclei stain), estrogen receptor negative, progesterone receptor negative, HER-2/neu negative and negative p-53 for over-expression. Coincidentally, ductal carcinoma in situ, Van Nuys grade 3 of 3, was demonstrated in two cores lining the fibrotic cyst wall. Ultrasound-guided core needle biopsy of the solid component yielded infiltrating poorly differentiated ductal carcinoma, grade 3 of 3 (Nottingham score = 8) in one core with the longest tumor extent in the core measuring 0.2 cm ( Figure 4). The cyst aspirate yielded 50 mL of dark maroon fluid, which was sent to cytology. Subsequent ultrasound guided right breast cyst aspiration was performed to decrease its size prior to the core biopsy, as well as to send fluid cytology to evaluate for malignant cells. Technique: Ultrasound and Color Doppler using a high frequency linear transducer (14 MHz). (c, d) Indeterminate soft tissue demonstrating vascularity is seen along the superficial and lateral margin of this mass (arrows), consistent with a complex solid and cystic mass. 67-year-old female with right breast invasive ductal carcinoma and ductal carcinoma in-situ.įindings: (a, b) The right breast demonstrates an oval, circumscribed, parallel, predominately anechoic mass with minimal layering debris between the 8 o’clock to 11 o’clock position, 4 cm from the nipple, measuring 8.8 × 4.3 × 7.5 cm.
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