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PET/CT Variants and Pitfalls in Breast Cancers
Elias George Kikano1, Stefanie Avril2, Holly Marshall3
1Department of Radiology, Division of Nuclear Medicine, Cleveland, Ohio; University Hospitals Cleveland Medical Center/Case Western Reserve University, Cleveland, Ohio.
Seminars in Nuclear Medicine
|June 5, 2021
Summary
F-18 Fluorodeoxyglucose Positron Emission Tomography (FDG-PET) can identify potential breast cancer but has pitfalls. Benign conditions and inflammation can mimic malignancy, requiring careful interpretation alongside anatomical imaging.
Area of Science:
- Nuclear Medicine
- Oncology
- Radiology
Background:
- F-18 Fluorodeoxyglucose Positron Emission Tomography (FDG-PET) is a valuable tool in oncology.
- Its application in breast cancer imaging requires careful consideration of potential diagnostic challenges.
- Understanding normal variants and pitfalls is crucial for accurate interpretation.
Purpose of the Study:
- To review the normal variants and pitfalls associated with FDG-PET imaging in breast cancer patients.
- To highlight factors that can affect the specificity and accuracy of FDG-PET in this context.
- To emphasize the importance of integrating FDG-PET findings with anatomical imaging.
Main Methods:
- Review of literature and clinical experience regarding FDG-PET in breast cancer.
- Analysis of factors contributing to false-positive and false-negative findings.
- Discussion of specific challenges in evaluating primary breast lesions and lymph node involvement.
Main Results:
- Focally increased glucose metabolism on FDG-PET suggests neoplasia but is not specific to breast cancer, occurring in other malignancies and inflammatory conditions.
- Benign breast disease can also show increased metabolism, limiting FDG-PET specificity.
- Axillary lymph node evaluation by FDG-PET is less accurate than sentinel lymph node biopsy but effective for advanced nodal disease; inflammation (e.g., post-vaccination) can cause false positives.
Conclusions:
- FDG-PET is not for initial breast cancer diagnosis but aids in evaluating suspicious findings and staging.
- Tumor heterogeneity, intracellular signaling, and benign mimics (including inflammation and post-vaccination changes) are key pitfalls.
- Careful correlation with anatomical imaging and awareness of these limitations are essential for optimal FDG-PET utility in breast cancer management.
