Breast oncology - website – 2010

Computed tomography

Computed tomography is a method of radiation diagnostics, which consists in the fact that rays pass through a particular area of ​​the body at different angles. After this, the information enters the computer, where it is processed and an image of a tissue section at a certain depth is formed.

Computed tomography is a non-invasive method (does not require surgery), safe and used for many diseases. Your doctor may order a CT scan if you have a large breast tumor to find out whether the tumor is operable or not due to its growth into the chest wall.

This method is better than plain mammography because mammography may have layers of tissue in the image, causing a small tumor not to be visible.

The installations for performing computed tomography are similar to those used for magnetic resonance imaging.

During a computed tomography scan, the patient lies down on a special plane, which smoothly gradually enters the cylindrical chamber where the X-ray emitter and sensor are located. As each slice is imaged, the emitter and probe make an arc around the area of ​​the patient that needs to be examined. Information from the sensor immediately enters the computer, where it is processed, combined with other images, and the result is a complete picture of the layer of a particular organ at a certain depth.

On average, the procedure takes from 30 to 60 minutes, but can reach 2 hours. It depends on the scope of the study.

Possible complications of CT scan

Possible complications of computed tomography include the development of claustrophobia in some patients. In this case, it is recommended to prescribe sedatives before the study. In addition, with numerous X-ray (including tomographic) research methods there is a slight risk of developing malignant tumors.

Computed tomography is contraindicated during pregnancy.

Magnetic resonance imaging – MRI

Magnetic resonance imaging is a method for examining the mammary glands using a powerful magnetic field. In this case, the mammary glands are irradiated with electromagnetic waves in a strong magnetic field. The principle of the method is that this releases electromagnetic energy, which is then recorded using sensors and subjected to computer processing.

Advantages of magnetic resonance imaging:

• allows you to identify a palpable tumor in women, in cases where it is not detected by mammography or ultrasound.
• Allows you to identify pathological changes in the case of high density of mammary gland tissue.
• allows screening of young women at high risk of developing breast cancer due to family history or the presence of an abnormal gene.
• Sometimes magnetic resonance imaging successfully detects a tumor in women with enlarged axillary lymph nodes, when the doctor cannot feel the tumor in the thickness of the breast or it is not visible on mammography. In such cases, where mastectomy is usually recommended, MRI can accurately reveal the location of the tumor in the breast. This allows you to avoid removing the entire gland and limit yourself to only a lumpectomy (removal of the tumor) followed by radiation therapy.
• Helps determine which area the cancerous tumor is limited to and its spread to neighboring areas. This influences the choice of surgical treatment tactics, since if the tumor is widespread and multicentric, mastectomy is recommended. This is especially true for patients with invasive lobular carcinoma, since the form of cancer most often tends to be widespread.
• Helps in the assessment of scar tissue in the thickness of the mammary glands, which allows you to monitor the area where the lumpectomy was performed for the presence of early relapses.
• Capable of detecting silicone leakage from a breast implant, as this test method can easily distinguish silicone gel from normal surrounding tissue.
• In the case of metastatic breast cancer, magnetic resonance imaging helps examine other areas of the patient's body for metastases and changes in organs. For example, if in this case the patient begins to experience back pain, weakness of the arms and legs, which is a possible sign of cancer metastasis to the spinal cord, a magnetic resonance imaging study of the spine is performed.

Before conducting a magnetic resonance examination, the doctor finds out whether there are any metal objects in the patient’s body, for example, artificial heart pacemakers, artificial metal joints. For such patients, magnetic resonance imaging is contraindicated. In addition, immediately before the examination procedure, a woman must remove all metal objects from herself - jewelry, clothes with metal buttons, etc.

Magnetic resonance imaging is carried out in a special narrow cylindrical chamber. As a result, some patients may experience claustrophobia when in confined spaces. Therefore, they are given a sedative if necessary.

How is magnetic resonance imaging performed?

The patient is placed in a strong magnetic field and exposed to electromagnetic radiation. The resulting electromagnetic energy is processed on a computer. This allows the milk tissue to be layered from different positions and angles. The magnetic field knocks out atomic particles in the tissues - protons, which are then accelerated by electromagnetic radiation and produce signals. These signals are received by sensors and further processed by computer. The result is a very clear image, allowing you to see fine details.

However, the magnetic resonance imaging method also has its drawbacks. First of all, this diagnostic method is expensive. Not all medical centers (even large ones) have equipment for this study. In addition, very often strange findings are found on magnetic resonance imaging.

Magnetic resonance imaging also cannot detect calcifications. In addition, the powerful magnetic field and electromagnetic radiation used during magnetic resonance imaging can damage a device such as an artificial pacemaker. Therefore, magnetic resonance imaging cannot serve as a diagnostic screening method.

Positron emission tomography

Positron emission tomography is a radionuclide tomographic method for studying internal organs. Positron emission tomography is successfully used in the diagnosis of patients with cancer metastases. The method is especially effective for assessing the condition of lymph nodes.

The positron emission tomography method is based on the fact that a special radiopharmaceutical is injected into the tissue. It contains radionuclides characterized by so-called positron beta decay. After the radiopharmaceutical has been administered, so-called “gamma quanta” are registered.

As already indicated, tumor cells are characterized by increased metabolism. this leads to the fact that they absorb the injected radiopharmaceutical from the blood faster and more strongly. Once the radioactive substance enters the tumor cell, its decay begins. During decay, special particles (quanta) are formed, which are recorded using special equipment. This method allows you to determine the area of ​​suspicious activity of cancer cells.

The positron emission tomography method allows us to clarify the following questions:

• Whether tumor cells remain after radiation therapy or chemotherapy.
• Is there spread of tumor cells to the lymph nodes?

Unfortunately, positron emission tomography also has disadvantages: this method can only be used to detect small tumors. In addition, positron emission tomography is a rather expensive diagnostic method; it is not available in all medical centers.

Questions: 38

Dmitry Andreevich, thank you very much for your answer to question No. 24806. I have a clarifying question: should a control CT scan of the chest be done with contrast (the previous ones were without) or without contrast? Will using contrast confuse the assessment of the lungs?

Hello, Natalia. I usually prescribe a CT scan with contrast. If a CT scan without contrast has previously been performed, I still order a study with contrast, although this can lead to some confusing situations.

Hello. Thanks in advance. My mother is 54 years old. Diagnosis T2N0M0. Immunohistochemistry: negative hormones. Her2+++. On CT (with contrast) the size of the tumor is 1.6 by 1.8 (small). In the lungs they found the following: hematogenous, scattered, single foci 0.5 mm - 1 piece, 0.3 mm - 2 pieces. The rest of the organs are clean. During the conversation, the CT doctor said that she could not say 100% that it was metastases, and the chemotherapist said that according to the CT results, it was stage 4 cancer. Question 1: could these lesions in the lungs really be metastases or perhaps fibrosis, or something else? How else can you be sure what these hotbeds are?

Hello, Alina. Judging by the description, although you should at least look at the conclusion, the chemotherapist is right. We are talking about stage 4 breast cancer with metastases to the lungs. You can double-check the images with another specialist - this is the only sure way to dispel doubts.

hello doctor! My mother’s image repeatedly showed a spot, but an ultrasound of the mammary glands did not reveal a tumor, the puncture was also good, but on the computed tomography they wrote a conclusion: nodular formation of the left breast (more data for BL), slightly pronounced lymphadenopathy of the axillary nodes. They took a puncture again, which what should we expect? thank you very much in advance

It is difficult to judge the nature of education from your description. If, according to the CT description, we are talking about a tumor suspicious for breast cancer, then, of course, a biopsy is required. In general, it is possible to discuss diagnostic and treatment tactics only after examination.

Hello, dear Dmitry Andreevich!! Sorry to bother you. I would like to know your opinion on one issue. In 2013, she received complex treatment for breast cancer. Secondary edematous-infiltrative form T2N2M0. Her negative, er 100 points, pr 40 points, ki 67-7%. There were 4 chemo treatments (doxorubicin, cyclonophosphamide) before surgery. Then the RME operation according to Madden. Pathomorphosis grade 3, 2 nodes out of 8. After surgery, 2 chemotherapy according to the same regimen, AS and radiation therapy. A week ago, I underwent PET-CT with radiopharmaceutical 18 f-fdg, metabolically active changes were revealed in the acrominal process of the left scapula, in the pedicle of the arch of the th1 vertebral body, in the l3 and s1 vertebral bodies, in the wing of the left ilium, characteristic of metastatic spread of the main oncological process . 18 f-naf PET/CT is recommended for bone metastases. Tell me, can PET make a mistake? Confuse some other disease with MTS? There is no pain syndrome. Sometimes my back hurts after a heavy lift, but it’s been hurting since school; I have very severe scoliosis. Thank you!

If the PET specialist is qualified and experienced, then the study is quite accurate. To diagnose bone metastases, it is optimal to first use bone scintigraphy, then targeted radiography of the lesions or CT. In any case, you need to rely on the opinion of your doctor.

to question 23709. Hello dear Dmitry Andreevich! After your answer, we are even more confused. In your book about CT, you write: “This method allows you to view the body in various modes - “soft tissue” and “bone”, which is not possible with any other method. And in Israel they told me that the darkening in the lungs is the consequences of radiation therapy. After all, as far as I understand, PET CT is much more informative than just CT. And the question was mainly aimed at understanding whether PET CT or a “standard” examination including bone scintigraphy is more informative and less harmful. When I was examined in April 2014, I also had pain in my spine and joints. And also, could these pains be a consequence of the treatment performed? From my extract: Recommended: Adjuvant polychemotherapy according to the scheme: 3 courses of FAC, then 3 courses of docetaxel 100 mg/m2 once every 3 weeks (G-CSF support). Simultaneously with docetaxel, start Herceptin 8 mg/kg - 6 mg/kg once every 3 weeks for 1 year. After completion of polychemotherapy, radiation therapy with a dose of 2 Gy is indicated. SOD for the left mammary gland 50 Gy, additional irradiation of the removed tumor bed 62-64 Gy. The Blokhin Russian Cancer Research Center, where I will be examined, also has PET CT equipment. Is there a difference in the equipment and qualifications of doctors at the Blokhin Russian Cancer Research Center and the Russian Research Center for Chemistry and Chemistry (RRCHT) (Pesochny settlement, St. Petersburg)?

CT scans can indeed be viewed in different modes, and this examination is less informative than PET-CT. The question is also who is looking at the pictures. It often happens that an experienced CT specialist produces results much better than a PET-CT specialist, however, the opposite can also happen. I am a supporter of performing CT scans (probably because I work with an experienced specialist who, by the way, also knows ultrasound). In your case, PET CT revealed changes, you were consulted in Israel, so it is optimal to do a control PET-CT examination there and compare the results of one diagnostic method. Scintigraphy is performed independently of PET-CT or CT. Bone pain may be related to treatment, as treatment may cause osteoporosis to worsen. Regarding qualifications, I cannot comment; I don’t know many patients who were examined in these centers. In any case, you need to rely on the opinion of your doctor.

Hello! Passed PET/CT. The Conclusion says PET/CT data for mts in bone. Please decipher what this means.

We are talking about bone metastases. In principle, we are talking about stage 4, and usually for bone metastases, bisphosphonates (zoledronic acid, etc.) are prescribed, which prevent pathological fractures, drug treatment (hormone therapy, chemotherapy). In any case, you need to rely on the opinion of your doctor.

Hello Dmitry Andreevich! On 05/22/2014 I underwent surgery: radical resection of the right breast. Diagnosis after surgery: cancer of the right breast T2N1M0, stage IIb, 2nd class group. Associated: Gilbert's disease. Additional data: Estrogen receptors: PS=4 IS=2 TS=6 - positive. Progesterone receptors: PS=3 IS=3 TS=6 – positive. HER2:1+ protein expression is negative. Ki67 expression: 10% - low. Invasion into blood vessels - yes, into the skin - no. Conclusion: invasive cancer, luminal type A; HER2 negative. After the operation, tamoxifen (20 mg/day) was prescribed for 5 years and a course of radiation was given to the operated mammary gland and armpit area (questions 21795 and 22300). According to spiral CT of the chest from 08/12/2014 and 10/02/2015: post-radiation pneumofibrosis of the right lung without dynamics. Today I had an abdominal ultrasound. The first control ultrasound was 08/10/2014. In it: the liver is located usually, not enlarged, the CVR of the right lobe is 10.9 cm, the anteroposterior size of the left lobe is 6.6 cm, the contours are smooth, the edges are sharp. The echostructure is homogeneous, echogenicity is not changed. The vascular pattern is not changed. The bile ducts are not dilated. The bile duct is 0.5 cm. According to today's ultrasound: the liver is located usually, not enlarged, the left lobe is 70 mm, the right lobe is 144 cm, the contours are smooth, moderately increased echogenicity, homogeneous. In the fifth segment there are two hypoechoic formations with smooth, clear contours, avascular, 8 * 7 mm and 13 * 9 mm, a similar formation in the eighth segment, 14 * 10 mm. Conclusion: cysts with suspension? . mts cannot be completely ruled out. An MRI of the abdominal cavity with contrast was scheduled for 02/21/2015. The rest of the ultrasound showed no features or pathologies. Thoughts haunt me. It is very difficult to pull yourself together. My question: 1. Is there a chance that these are not metastases.2. Something similar may actually appear in six months, or you didn’t notice anything in October.3. Although it’s bitter to ask, I can’t help but ask: can I be cured if, God forbid, it’s still metastases.

There is a chance that these are not metastases; an MRI or CT scan of the abdominal cavity is advisable in your case. If we are talking about hemangiomas (often CT specialists cannot understand the situation of a hemangioma or metastasis of breast cancer, and therefore we often do a liver biopsy), then a very good method of differential diagnosis is liver scintigraphy (currently performed in St. Petersburg, at the Institute of Phthisiopulmonology on Politekhnicheskaya street). Unfortunately, metastases can appear at any time. It’s useless and harmful for you to twitch and beat yourself up now. We must wait for the results of the examination; unfortunately, fortune telling on coffee grounds usually only leads to additional stress.

Hello, dear Dmitry Andreevich! Lyudmila, 57 years old. Breast cancer, pT2N0M0, RME on the left from 04/29/2013. IHC-ER+++, PR-(neg), Ki67-5-10%. Invasive ductal carcinoma with multiple foci of intraductal carcinoma. There was no chemotherapy or radiation therapy, long-term exemestane since 08/2013. I regularly undergo follow-up examinations. Last year I had a PET/CT scan at the Russian Research Center for Radiology and Surgery. technology is evil without activity. process. And 03/25/2015-PET/CT there were no signs of local relapse of the disease, as well as its regional spread at the time of the study. FDG hypermetabolism (SUV max = 2.05-2.30) of a focal nature in the bronchopulmonary lymph nodes (inflammatory in nature? specific lesion?), dynamic control is recommended. What do you think about this, your opinion? My oncologist could not clarify the situation...Are these metastases???Thank you.

I think that everything was done correctly and a follow-up examination really needs to be carried out. PET/CT is not a 100 percent diagnostic method and a specialist cannot always answer the question of what is happening. In such cases, a follow-up examination is advisable. Of course, a specialist must interpret the data not just from the picture, but taking into account the history of the disease and the current condition. If the lymph nodes shrink, then most likely their increase was due to inflammatory causes. However, again, all factors must be taken into account.

Dmitry Andreevich, hello. My mother (53 years old) has breast cancer, mastectomy in 2013, non-hormone dependent, her2neu 3+, every 3 months she donates blood for tumor markers, she underwent scintigraphy in July, no metastasis was detected, a week ago she had a CT scan of the abdominal and thoracic area, but without contrast ( no changes were found), the question is: on a CT scan without contrast, are metastases visible or is it better to redo it with contrast? Should a CT scan of the brain be done? And tumor markers - are they informative, should we continue to check them? Thank you very much in advance

I usually recommend performing a CT scan with contrast only. Regarding whether or not to redo the CT scan, I probably wouldn’t do it, but for the future I would recommend doing it only with contrast. A CT scan of the brain is performed if brain metastases are suspected. Tumor markers are informative if their increase was determined before the start of treatment. In any case, you need to rely on the opinion of your doctor.

Hello! History of left Madden mastectomy in 2009. Radiation therapy at a dose of 40 gray, chemotherapy (doxorubicin + taxotere). I have been taking Arimidex for 5 years. In connection with the clinical picture and suspicion of pneumonia on the right, an X-ray of the lungs was taken, which revealed a lesion of up to 5 mm, a CT scan of the lungs was recommended. CT scan of the lungs: on CT scan the lung fields are straightened. On the right in the 10th segment, subpleurally, there are three focal formations close to a spherical shape, measuring 0.5, 0.7 and 0.9 cm in diameter with relatively clear uneven contours with a density of +10 - +50, around the lesions there is thickening and deformation of the pulmonary pattern (moderately pronounced path to the root). In segment 4 there is rough fibrosis. The remaining fields are without focal and infiltrative changes. The lumen of the bronchi is free. The roots are not expanded. Enlarged intrathoracic lymph nodes are not detected. The CT picture may correspond to nonspecific lower lobe focal pneumonia, a specific focal process of the lower lobe of the right lung, or a secondary lesion of the right lung. What is your opinion on further tactics, since I think that the time factor plays a role here. Is it possible to send you a CT scan as an attached file? Thank you.

Frequently asked questions:

What does it diagnose?

• Breast cancer

Equipment :

PET/CT for breast cancer

PET/CT for breast cancer

Breast cancer is a malignant formation of the glandular tissues of the mammary gland. According to various statistical centers, breast cancer cases account for up to 25% of all diagnosed cancers. Every year in our country alone, the disease claims the lives of 25 thousand women. The global figure is even more impressive. Therefore, the modern medical community places emphasis on early diagnosis of breast cancer, which not only prolongs life and improves its quality for cancer patients, but also significantly increases the chances of a full recovery.

PET/CT is the most informative and accurate method for diagnosing malignant breast tumors at the moment.

Diagnostics before PET/CT.

In general, diagnosis of suspected breast cancer begins with an ultrasound or mammography followed by consultation with an oncologist. As additional and clarifying studies, puncture biopsy and MRI can be performed. Magnetic resonance imaging is a fairly accurate research method that allows you to localize tumors. The reliability of MRI in diagnosing breast tumors (especially in conjunction with a biopsy) reaches 80%, which is significantly higher than that of mammography, but slightly less compared to PET/CT. However, it has one significant drawback - the tomograph is not able to recognize tumors in the early stages, when their diameter does not exceed 5 mm.

Indications and contraindications for PET/CT.

Indications for PET/CT are:

• diagnosis of breast cancer in the early stages;
• choice of treatment method;
• monitoring of the chosen treatment method;
• search for regional metastases;
• breast cancer staging;
• search for the primary tumor;
• assessment of response to therapy (chemo- or radiation) and surgical treatment;
• predicting the possibility of relapse;
• breast cancer recurrence study.

PET/CT is a non-invasive and safe method, but despite this, it is carried out only with the direction of the attending physician. In addition, like any other study, it has its own list of contraindications:

• high level of glucose in the blood (PET/CT can be performed only after consultation with an endocrinologist and the sugar level has been reduced to an acceptable level);
• pregnancy (PET/CT is only possible if the importance of obtaining information is higher than the expected risks);
• lactation period (the procedure is also possible, but breastfeeding within 2 days after the examination is not allowed);
• renal failure (difficulties may arise with the removal of the radiopharmaceutical, but the possibility of PET/CT is allowed after renal tests and the conclusion of a nephrologist).

Advantages of PET/CT.

Currently, this is the most accurate method for diagnosing cancer tumors in cancer patients. Compared to other examinations, PET/CT has a number of advantages:

1. high reliability of the data obtained (up to 90% when detecting breast cancer and up to 40% when searching for regional and distant metastases);
2. the ability to see cancerous changes at the molecular level;
3. helps to create individual treatment courses and predict the development of cancer in the coming year;
4. the possibility of objective assessment of the effectiveness of the treatment;
5. In addition to localizing structural changes in breast tissue, you can also obtain information about the quality of ongoing processes.

Preparing for the study.

As such, preparation for the study is not required. There is only a list of recommendations, following which PET/CT will be performed with the least discomfort, and the results obtained will be more indicative:

• do not drink any alcohol for at least 2 days;
• one day before the appointment, do not drink tonic drinks or smoke, and do not eat food 6 hours before PET/CT;
• It is recommended to get enough sleep and rest before the study;
• find out your weight - this is necessary for accurately calculating the dosage of a radiopharmaceutical (RP);
• To better remove radioactive substances from the body, drinking plenty of fluids on the eve of the procedure is recommended.

If you have one of the above contraindications, you should inform your doctor about it in advance.

How is it carried out?

Upon arrival at the site for PET/CT of the breast, it is necessary to remove all metal elements from clothing and the body.

Next, a radiopharmaceutical is administered intravenously; in the case of the mammary gland, 18-fluorodeoxyglucose is used. When the drug is evenly distributed throughout the body tissues (about 1 hour is required), the patient is placed on an open table (no closed chambers, which is also a plus compared to MRI). From this moment, the sensors examine the selected area centimeter by centimeter, transmitting the received information to the software of the device, which creates a metabolic map of the body.

Interesting! PET/CT diagnostics are carried out in the “whole body” mode, which is inappropriate when examining a small area - the breast in this case. Pilot studies are currently underway on completely new PET scanners, designed specifically for breast examination and capable of highly efficient detection of lesions up to 5 mm in size.

Upon completion of the procedure, the doctor performs a follow-up examination of the patient, after which you can safely go home. The results of the study are deciphered within 3 days, after which the conclusion is given to the patient or sent to his attending physician.

Cost of the study.

Breast PET/CT examination can be performed in both public and private medical centers, both on a paid and free quota basis.

Important! To undergo a free PET/CT scan, you must have a health insurance policy and a referral from your attending physician.

But it is worth understanding that the number of people willing to undergo such an examination for free is disproportionately higher than the capabilities of our medical institutions. Therefore, the waiting list for an appointment can last for months.

A paid PET/CT scan will significantly speed up the process, where the queue for the procedure, as a rule, does not exceed 5 days. But, unfortunately, not all Russians can afford such an expensive service. The price of PET/CT is on average 55,000-90,000 rubles and depends on the location and prestige of the medical center, level of patient service, quality of equipment and complexity of the case.

15.11.2017

QUESTION: Vitaly Aleksandrovich, according to the results of a CT scan with contrast (2 months have passed since the mastectomy) in the left axillary region - postoperative hardening of soft tissues in an area of ​​​​about 25x19x32 mm, with perifocally dense subcutaneous tissue. What does this mean?

ANSWER: Hello! This means that most likely you have a lymphocyst there and it needs to be punctured, or simply fibrosis. You did this research early, the tissues have not yet had time to heal and recover! It would be better if you show this soft tissue thickening to your oncologist.

02.12.2017

QUESTION: Vitaly Alexandrovich! CT scan with contrast, the diagnosis of avascular necrosis of the right shoulder joint is questionable. Cysts of the head of the right shoulder joint 8 mm and 3 mm. Do you think that if the contrast has not accumulated, you can be 100% sure that it is not MTS?

ANSWER: I think it’s not MTS after all! In the metastatic process, other signs of bone damage!

01.02.2018

QUESTION: Vitaly Aleksandrovich, according to the conclusion of computed multislice tomography with a contrast agent of 800 ml of 3% trazograf solution orally and 40 ml of ultravist intravenously, single focal compactions in the lungs are of the fibrous series? (CT control), small single foci of sclerosis in the bones of the studied level. Based on this conclusion, from your point of view, is there cause for concern? Thanks a lot.

ANSWER: Hello! Given a history of breast cancer, you should always be observed and look at these lesions, you just need to do it regularly!

05.02.2018

QUESTION: Vitaly Alexandrovich, please help. Mammography 8 months ago revealed a lump of about 3 cm in the left breast, upper outer quadrant. That's almost all the description. Repeated M-graphy after 6 months is recommended. There is aching pain in the breast, sometimes it depends on the cycle, sometimes not. The left shoulder blade and left hypochondrium also hurt. There was an injury to the left hypochondrium 25 years ago. But she didn't bother me. An X-ray of the ribs shows only the old crack of the ribs. I have a lumbar intervertebral hernia. The neurologist explains that the degenerative process could also affect the thoracic spine. Hence the pain in the scapula, which radiates to the breast, but I recommended checking the breast. Intercostal neuralgia was excluded by the neurologist. The left breast is slightly larger than the right. But it was like that before. I did an ultrasound three times and the descriptions were completely different. But according to the doctors, there is nothing criminal. The mammogram was extremely painful, there was a lot of pressure on the breast, so I did an MRI without contrast. Without contrast, nephrologist's recommendation. There are no MRI descriptions without contrast, but there are pictures and a disk. At the clinic where I had an MRI, they said that there was no point in doing an MRI without contrast. Is that so? Did I do an MRI without contrast in vain? Or can pictures help clarify the picture? What are your recommendations for my next steps? Still a repeat mammogram? Puncture?
Thank you in advance!
Best regards, Evgenia.

ANSWER: Hello! Does your institution where you do mammography (mammography test) - this is mammography with simultaneous biopsy under X-ray control - it definitely doesn’t miss! This is the first thing you can do! The second is an MRI with contrast, but the essence is the same, namely - no biopsy! Therefore, perhaps there is no point in MRI! !Or the simplest method is ultrasound-guided biopsy! It seems to me that you have nothing there, with such pain as yours, there would have been metastases in other places long ago, there were visible manifestations on the gland, so do as I said - an ultrasound-guided biopsy or a mammography test! Have you contacted your oncologist, he should know all this! Where do you live?

07.03.2018

QUESTION: Vitaly Aleksandrovich, I already asked you a question, you turned out to be right, they confused me in the epicrisis, instead of non-adjuvant therapy they wrote adjuvant therapy. I would like to repeat my question: after non-adjuvant therapy and organ-saving surgery, my epicrisis says - therapeutic pathomorphosis of the 1st degree. Is it possible to make a prognosis based only on pathomorphosis? Thank you.

ANSWER: Hello! Why did you undergo organ-saving surgery with such an advanced process? Neoadjuvant chemotherapy is done for advanced or edematous breast cancer. Organ-conserving surgery is usually not performed after neoadjuvnt chemotherapy! It seems to me that the prognosis will not be very favorable, since the standardization of treatment has been violated! To improve this indicator, you need to undergo radiation therapy and resolve the issue with adjuvant chemotherapy!

18.03.2018

QUESTION: Vitaly Alexandrovich, is it possible to do a CT scan with contrast immediately after radiation therapy? Or is it better to take a break? Thank you.

ANSWER: Hello! Of course, you can do it, but there is no point, it is better to do it after 6 months, but do not be alarmed if in conclusion there are changes in the lungs like frosted glass! These are typical changes in the lungs after radiation therapy - post-radiation fibrosis!

08.04.2018

QUESTION: Vitaly Aleksandrovich, in the description of multislice computed tomography with contrast agent 800 ml of 3% trazograf solution orally + 40 ml of ultravist intravenously: focal compactions were noted in the lungs: on the right in S8 - 3x2 mm and on the left in S4 in the raincoat sections - 2mm d . Also on the right in S1 is a pleuropulmonary commissure. Could these isolated focal densities be fibrous? be a consequence of radiation therapy. Thank you.

ANSWER: Hello, based on these signs, most likely you have focal fibrous compactions, which could well be a consequence of radiation therapy; in this case, a CT scan is usually monitored after 3-4 months!

08.04.2018

QUESTION: Vitaly Alexandrovich, good evening! After mastectomy, before chemotherapy, I had a CT scan with contrast. In conclusion, small isolated foci of sclerosis in the bones of the studied level are written. At the level of the study, small foci of sclerosis were noted in the head of the right humerus - 1 mm, in the anterior parts of the Th5 vertebral body - 1 mm, in the right parts of the L2 vertebral body - 3x2 mm and in the roof of the right acetabulum - 1.5 mm d. Do I have a reason to worry? Thank you.

ANSWER: Hello! There is always a reason for concern, since there is a history of breast cancer, in this case you just need to do a CT scan to control this study!

08.04.2018

QUESTION: Vitaly Aleksandrovich, with a CT scan of the chest organs, the left mammary gland has been removed, in the left axillary region there is a postoperative thickening of soft tissues in an area of ​​​​about 26x18x31 mm, with perifocally dense subcutaneous tissue. No additional formations were identified in the right mammary gland, the right axillary lymph nodes were without pathological enlargement up to 10 mm d and max 14 mm d. with fatty involution. 2 months have passed since the mastectomy. Is this CT description a variant of the norm? Thank you.

ANSWER: Hello, in your case this is the norm for you!

23.07.2018

QUESTION: Hello, Vitaly Alexandrovich! Please consult. Breast cancer, triple negative cancer. surgery in March 2017, the last chemotherapy was in September 2017. On a routine CT scan in July 2018, they write - lymphadenopathy of the retroperitoneal lymph node of a nonspecific nature and lymphadenopathy of the mediastinal nodes, the size of the lymph nodes is 5-6 mm. The doctor said this is normal. I would really like to hear your opinion on this matter - is there really nothing wrong with this or does it still indicate an ongoing oncological process?

ANSWER: Hello! Indeed, your doctor is right: these are normal lymph nodes and now it is impossible to say that they are malignant! This is the norm! You just need to repeat the CT scan in 3-4 months and if everything is the same, then do this study once a year!

12.11.2018

QUESTION: Hello, Vitaly Alexandrovich! TN BC, organ-preserving surgery, 8 courses of chemotherapy and radiation, treatment completed in September 2017. I contacted you with questions. Thank you very much for your answers. A CT scan from the moment of diagnosis showed lymphadenopathy of the retroperitoneal lymph node and mediastinum. On the last CT scan it was written that these lymph nodes began to accumulate contrast. I did not have any colds or infectious diseases during the three months between CT scans. Please tell me what this could mean?

ANSWER: Hello! This can mean anything, the accumulation of contrast occurs not only in a malignant process, in your case it is necessary to exclude the progression of the tumor, the specialist describing the CT scan of this department should specifically say what it is! We need to ask him this question. Also, to exclude this tumor progression, mediastinoscopy is sometimes performed. What your oncologist tells you, he knows you better. My advice: in this case, it is necessary to exclude progression and therefore you need to contact an oncologist at your place of residence.

13.11.2018

QUESTION: Vitaly Alexandrovich, thank you for your answer to the question about the accumulation of contrast in lymph nodes. That's why I turned to you, because my doctor says that this is the norm and let me go until March. But what still worries me is that they didn’t accumulate contrast before. Maybe we should do a PET scan?

ANSWER: Hello! You can do a PET scan if you have such an opportunity, but if your doctor is sure that there is no growth of nodes over time, then this really happens, I wrote to you about this in the first answer, that accumulation does not only happen with malignant formations! If there is no dynamics, then it means we really need to postpone the study to March!

20.11.2018

QUESTION: Good afternoon, Vitaly Alexandrovich. I was treated for breast cancer with a mastectomy in February 2018, chemotherapy and radiation. I did a CT scan of the lungs. Conclusion: a single lesion in S1 of the right lung. Post-radiation changes in S4-S5 of the right lung. In the area of ​​surgical intervention, fluid accumulation is 5.8x8.4x1.3, with a density of +10HU. Could you please explain the result. Thanks in advance.

ANSWER: Hello, on your CT scan they wrote that you have post-radiation changes in the area where the gland was irradiated, they also wrote that there is a suspicion of cancer metastasis to the lungs in the S 1 segment, but this needs to be looked at over time in 2-3 months, the treatment should not be changed now and it seems to me that this is most likely not cancer metastasis, but also some changes that were previously or associated with radiation therapy!

12.12.2018

QUESTION: Is it safe to do a CT scan after surgery when the stitches have not yet been removed?

ANSWER: Hello! Of course, this procedure is safe, and you can perform it if you were prescribed this test and now after the operation it makes sense.

03.01.2019

QUESTION: Vitaly Alexandrovich, thank you very much for your quick response! Tell me, please, when after the end of treatment can and should CT and osteoscintigraphy be done? And what three zones should be examined on CT? And also regarding tamoxifen, should you basically take it 2 times a day or can you take 20 mg once a day? Is varicose veins a contraindication? Maybe I should drink something for prevention? Thank you!

ANSWER: Hello! CT scan of three zones - chest, abdomen and pelvis, a year after the last CT scan, if you have not had a CT scan, you can do it now, or better yet, 6 months after radiation therapy and then do it every other year, do it once a year , you can even today! It is better to take Tamoxifen 20 mg once a day than 10 mg twice a day! Varicose veins are not a contraindication, take it calmly! To prevent thrombosis, it is better to seek advice from a vascular surgeon; in Russia they take, for example, thromboass or cardiomagnyl!

02.02.2019

QUESTION: Good afternoon I have been worried about problems with my lungs for at least 15 years. No one has determined anything. Personally, I suspect chronic inflammation or tuberculosis. There is practically no cough or sputum. Pain in the back position and breathing problems are relieved with antibiotics. There is constant purulent content in the nose, it flows into the respiratory tract - there is no treatment - 30 operations (osteomyelitis?). According to PET, the lesions in September 2018 were inactive, multiple, after 1.5 months. according to CT - the same foci (fibrosis) are already MTS. I am undergoing chemotherapy and at the same time taking antibiotics on my own. I think prednisolone and dexamethasone make things worse when your white blood cells are low. Antibiotics reduce ESR. The pus in the nose becomes more active. Laura is tired and shy away. I don't believe in MTS. What is your opinion? Thank you.

ANSWER: Hello! You didn’t even indicate what cancer metastases you have!!! Phthisiatricians have ruled out tuberculosis? During chemotherapy, all concomitant diseases always worsen. My opinion on what exactly do you need?

10.09.2019

QUESTION: MSCT showed moderate febrile indurations, is this cancer?

ANSWER: Hello! In any examination there is a description of this examination method and at the end a conclusion, which states what is being discussed and the diagnosis. What you are asking me is most likely not cancer, contact a specialist with this conclusion, and he will comment on it for you.

27.09.2019

QUESTION: Hello, a month and a half ago I caught a cold - I had a runny nose, cough and the temperature lasted for 3 days! everything went away; all that was left was a cough with copious sputum, similar to snot! doesn't work! I had an X-ray and my lungs were clean, then the therapist sent me to a Pulmonologist. They did an FVD - the test was negative, and a CT scan of the lungs! The CT scan shows the following picture: - C4.5 fibroatelectasis of the right lung with traction bronchoetasis. Deformation of the lumen of the bronchi PB4, PB5 and SDB. The walls of the segmental and subsegmental bronchi in C3 on the right are emphasized in a muff-like manner. - in other segments without foci and infiltration - VGLUs are not enlarged - fluid in the pleural cavities is not detected - the trachea and large bronchi are patent - the heart is not dilated, the ascending aorta is 38 mm. Calcium salts along the anterior variable of the left coronary artery - soft tissues are not changed - DDZP was sent for repeat to a pulmonologist, recording after 10 days only. Can you briefly decipher it, otherwise I’m very worried! Nothing bothers me except the cough. Thank you! They recommend bronchoscopy, but they say that they cannot see the tumor! They just don't say it?!

ANSWER: Hello! I am not an expert in this area, consult a thoracic surgeon.

24.10.2019

QUESTION: Hello! How long after scintigraphy can PET-CT be performed? Thank you.

ANSWER: Hello! Isotopes after osteoscintigraphy are removed within 24 hours, I think that this study can be performed after maintaining this interval, the specialist who performs the PET study can accurately answer your question.

25.10.2019

QUESTION: Hello! Diagnosis of breast cancer T2N1M0 ER40% 4 points, PgR 40% 4 points. HER2/neu0, Ki67 more than 20%. They prescribed 8 chemo treatments, after the 6th they did osteoscintigraphy - scintigraphic signs of a single focus of hyperfixation of radiopharmaceuticals in the manubrium of the sternum and small foci of increased accumulation of radiopharmaceuticals in the projection of the 1st rib on the left. To confirm, they sent me for a CT scan, the conclusion: signs of a formation in the left mammary gland; mts of the sternum cannot be excluded. What does this mean, what is the forecast? And has the diagnosis been established accurately, regarding metastases, or is some other examination needed to clarify? Thank you.

ANSWER: Hello! In this case, there is a suspicion of metastases in the bones, for this you need to look at the dynamics again in a few months with a CT scan, now continue treatment according to this regimen, the prognosis is based on the full picture of this disease, that is, confirmation of metastases in the bones. This examination has been completed and is sufficient.

26.10.2019

QUESTION: Good afternoon To accurately determine the presence of metastases in the spine and describe their size and further monitor the dynamics of treatment, which is better to do an MRI or CT scan of the spine?

ANSWER: Hello! In this case, it is best to perform computed tomography, ideally PET, but CT is sufficient because it is the most accessible and accurate method for assessing the dynamics of metastatic lesions.

02.11.2019

QUESTION: Hello, 2 weeks ago I had oncoplastic resection of the left breast and axillary lymphadenectomy. Tumor less than 2 cm, according to histology: infiltrative streaming cancer of 2nd degree of malignancy with invasion of lymph vessels; tumor growth in seven lymph nodes. There is no IHC conclusion yet. Please tell me whether there is any point in carrying out additional examinations (CT, MRI) now; Before the operation, I only did an ultrasound (breast, abdominal and pelvic) and an x-ray of the lungs.

ANSWER: Hello! As a result, the stage is high and there is, of course, a point in performing a computed tomography to exclude a metastatic process to other organs.

05.11.2019

QUESTION: Is it possible to find out whether pulmonary fibrosis and metastases are the same wording or different diseases?

ANSWER: Hello! Of course, these are different processes, and they have different clinical pictures when described on tomograms.

05.11.2019

QUESTION: Good evening! She underwent fluorography as planned, which showed that the left root was enlarged and polycyclic. Then a CT scan of the lungs was performed: the airiness of the lung tissue was not changed, focal and infiltrative changes were not identified. The lobar, segmental and subsegmental bronchi are not deformed and have a normal lumen. the pleural cavities are free, the pleural layers are not changed, the lymphatic nodes of the left root are enlarged to 13 mm. There are no formations in the mediastinum. Heart unchanged. No bone destructive changes were detected. Conclusion: Lymphadenopathy of bronchopulmonary lymph nodes on the left. What does this mean?

ANSWER: Hello! This conclusion should be interpreted by the radiologist who described this image; it seems to me that in this case there is nothing serious, and an enlarged lymph node may be normal.

Positron emission tomography (PET) has recently become an increasingly popular research method used to detect, stage and monitor various malignant tumors. The method is based on recording gamma radiation emitted by radioactive elements (radionuclides), which are introduced into the human body as part of special labeled substances - radiopharmaceuticals (RP). When combining a PET scanner with one, they talk about combined positron emission and computed tomography (PET-CT).

The combination of PET and CT allows you to combine “functional” (PET) and “anatomical” (CT) tomograms, which provides advantages over using only CT, because anatomical sections are supplemented with information reflecting functional changes. Thus, when comparing the changes detected by PET-CT (58 patients took part in the study) with data obtained only on the basis of CT, combined PET-CT showed better results in identifying small tumors and multiple metastases; as well as in detecting tumor-affected lymph nodes and assessing response to chemotherapy for breast cancer.

What is the difference between CT and PET-CT for breast cancer?

Methods such as CT and MRI are based on visualization of anatomical structures in order to identify pathological changes in patients with breast cancer, staging and control. At the same time, positron emission tomography (PET) makes it possible to detect pathological changes in the metabolism of 18-fluoro-2-deoxy-D-glucose (FDG), which makes it possible to obtain high-quality information about its accumulation in the tumor, and is a critical point in the diagnosis diagnosis and during control studies. The combination of PET-CT has advantages over the isolated use of PET, since it becomes possible to more accurately assign foci of increased FDG uptake to specific anatomical areas. In addition, this method reduces the research time. PET-CT also makes it possible to partially overcome the limited specificity of PET, which can detect foci of glucose hypermetabolism in benign tumors and inflammatory tissues (for example, in tuberculosis). A necessary condition for the information content of the method is a reliable assessment of the images by an experienced radiologist, sometimes using.

Early diagnosis of breast cancer

Breast cancer is the most common neoplasm in women worldwide and the leading cause of cancer-related mortality in women. Worldwide, there are approximately 1.38 million new cases of the disease each year, as well as 458,000 annual deaths due to the disease. Many risk factors are well known. However, the exact causes of breast cancer have not been determined. For example, having the disease in relatives and ancestors is a well-known risk factor: it increases the likelihood of developing cancer by two or three times. It is also assumed that mutations in the BRCA gene (1 and 2) and mutations in the p53 protein significantly increase the risk of tumor development. Early diagnosis is a fundamental method of control, as it determines the method of treatment, as well as the patient’s prognosis and chances of survival.

How to detect breast cancer

Diagnostic methods based on the detection of anatomical changes include ultrasound examination (ultrasound), and. They are widely used in clinical practice to identify the primary tumor and determine the stage of breast cancer. These diagnostic methods are constantly improving, in addition, new methods of studying the mammary glands are also being introduced into practice: optical mammography, single photon emission tomography (SPECT) and positron emission tomography (PET), which allow transferring information regarding anatomical changes, function, metabolism from the macroscopic to the molecular level.

Radionuclide research methods, including SPECT and PET, make it possible to assess in vivo the cellular, molecular and biochemical features of neoplasms and normal tissues. While "anatomical" diagnostic methods emphasize increasing spatial resolution and image quality, the goal of using radionuclide methods is more specific - increasing the contrast between the tumor and normal tissues.

In combination with traditional radiation diagnostic methods, radionuclide research methods, which allow visualization of biological processes, have made it possible to take a step forward in cancer detection. And now the new goals of using radionuclide methods are to separate various biochemical changes in tissues.

Evaluation of the Primary Tumor

The ability to detect breast cancer using PET depends on the size and tissue structure of the tumor. The sensitivity of PET is reported to be 68% for small tumors (less than 2 cm), and 92% for larger tumors (2-5 cm), however, the overall accuracy for detecting cancer in situ is low (sensitivity is 2-25%) . Thus, the main factor limiting the use of PET in breast imaging is the low detection rate of small tumors and noninvasive cancers.

Ductal carcinoma insitu in a 49-year-old woman. A: Ultrasound reveals a hypoechoic mass formation measuring 2.5 cm with indistinct edges, located in the upper parts of the left breast (marked by arrows). B: PET-CT scan shows no evidence of increased FDG uptake in the left breast. Surgery confirmed non-invasive ductal carcinoma.

However, the method plays an important role for some groups of patients, for example, with dense mammary glands or with the presence of implants. Positron emission tomography is used to determine the multiplicity of tumor lesions; to identify the location of the primary tumor in patients with metastases, when mammography is uninformative; as well as in those patients for whom biopsy is contraindicated. PET-CT has potential advantages over isolated PET in the evaluation of small lesions that may show reduced FDG uptake due to the partial volume effect of PET, since glucose hypermetabolism can be characteristic of both pathological and normal anatomical structures.

Invasive breast cancer in a 57-year-old woman. A: a screening radiograph of the left breast in an oblique mediolateral projection reveals a space-occupying formation with spicule-shaped edges, about 1.1 cm in size (marked by an arrow). B: PET scan revealed a focus of mild FDG hypermetabolism (standardized uptake level = 1.2) in the left breast. The lesion is difficult to detect due to the partial volume effect. C: PET-CT identifies a focus of FDG hypermetabolism in a limited area (marked by an arrow) in the left mammary gland.

Assessment of secondary lymph node involvement

The second objective of the method is to detect breast cancer metastases in the lymph nodes. Metastatic lesions of the axillary lymph nodes are an important factor determining the prognosis. Patients suffering from breast cancer with secondary damage to four or more axillary lymph nodes have a significantly higher risk of relapse. PET sensitivity for imaging axillary lymph nodes in patients with breast cancer has been reported to range from 79% to 94% and specificity to 86% to 92%. With PET-CT, it is possible to accurately determine the location and distinguish from each other lymph nodes secondarily affected by the tumor and reactively changed (non-cancerous) lymph nodes, while CT will reveal only multiple enlarged lymph nodes of the axillary group without clear differential signs.

Axillary lymph node metastases in a 45-year-old woman with invasive ductal breast cancer. A: PET shows a focus of FDG hypermetabolism in the right gland (black arrow) and in the axillary region (white arrow). B: CT scan reveals two enlarged axillary lymph nodes on the right (marked by arrows). C: PET-CT allows you to determine the exact localization of lymph nodes secondarily affected by the tumor (white arrow, standardized level of radiopharmaceutical accumulation = 9.9); a reactively changed lymph node is also visualized (black arrow). Among 21 lymph nodes removed during surgery, metastases were detected in only one.

Metastases of breast cancer to intrathoracic or mediastinal lymph nodes often do not manifest themselves clinically. The number of detected pathological changes in intrathoracic or mediastinal nodes (in patients with metastatic or recurrent breast cancer) with PET is almost twice as large as compared with traditional CT. In addition, PET-CT appears to be more useful than CT for the evaluation of hilar and mediastinal lymph nodes, since the ability of CT to detect metastases in small lymph nodes is quite limited.

Metastases to the mediastinal lymph nodes in a woman who underwent a modified radical left mastectomy 10 months ago. A: PET scan reveals multiple areas of radiopharmaceutical hypermetabolism in the left upper chest. B: CT image shows a small area of ​​soft tissue density in the anterior mediastinum (marked with an arrow). B: PET-CT revealed that the soft tissue area in the anterior mediastinum identified on CT correlates with an area of ​​FDG hypermetabolism, suggesting metastases to the hilar lymph nodes.

Evaluation of distant metastases

Breast cancer often gives distant metastases to, and. The advantage of whole body PET over traditional diagnostic methods, such as chest radiography, skeletal scintigraphy and abdominal ultrasound, is the ability to detect distant metastases in various areas of the body and organs during one study. Whole body PET has been found by Moon et al to have high diagnostic accuracy in patients suspected of having recurrent or metastatic cancer. Based on the number of lesions detected, the sensitivity of the method in detecting distant metastases was 85% and the specificity was 79%.

Multiple distant metastases in a 44-year-old female patient suffering from cancer of both glands. A: PET scan shows multiple areas of FDG hypermetabolism in the chest and abdomen. B,C: PET also revealed areas of FDG hypermetabolism in both mammary glands (marked with white arrows on the tomogramB), in the lymph nodes of the mediastinum (marked with black arrows on the tomogramB), and in internal organs (marked with arrows on the tomogramC).

In a study (Cook et al.), PET was found to be superior to skeletal scintigraphy in detecting osteolytic metastases from breast cancer. Conversely, osteoblastic metastases are characterized by low metabolic activity and are often undetectable by PET. However, PET-CT overcomes this limitation: osteoblastic metastases, even if not visible on PET, will be visualized on CT scans.

Bone metastases in a 64-year-old woman who underwent right modified radical mastectomy 36 months ago. A: Skeletal scintigraphy reveals foci of FDG hyperfixation in the first rib on the right and the seventh rib on the left (arrows), which are most likely associated with metastatic disease of the ribs.B: PET-CT shows no FDG hypermetabolism in the left seventh rib (arrow).C: CT scan reveals an osteoblastic lesion on the left seventh rib (arrow).

Breast cancer treatment

To treat patients whose tumor is large or has local spread, neoadjuvant chemotherapy is used to reduce the stage of the primary tumor before surgery and eliminate metastases. In addition, several studies have demonstrated that survival of patients with refractory tumors may be improved by using alternative chemotherapy and/or by lengthening chemotherapy courses. Since chemotherapy has side effects, it is necessary to identify patients who do not benefit from the treatment as quickly as possible.

Currently, radiodiagnostic methods are often used to determine the response to therapy by assessing changes in tumor size. However, serial measurements of tumor size in many cases do not allow inferring the presence of an early response. The effectiveness of PET in assessing response to therapy has been confirmed for various types of neoplasms. A study by Smith et al showed that the mean reduction in FDG uptake after the first course of chemotherapy was greater in lesions that showed a macroscopic partial or complete response, or a microscopic complete response, compared with resistant lesions. in histopathological studies. According to (Rose et al.), after a single course of chemotherapy, positron emission tomography was able to predict complete response to therapy on pathological examination, with a sensitivity of 90% and a specificity of 74%. If we take the degree of decrease in FDG uptake less than 55% of the initial value as a threshold value indicating the presence of a response to treatment, changes in PET in all respondents in this study were correct and confirmed pathologically (100% sensitivity and 85% specificity).

Images illustrate chemotherapy management in a 35-year-old female patient with breast cancer with bone metastases. A-C: Initial PET (A, B) and PET-CT (C) show significant FDG hypermetabolism in both breasts and in many vertebrae.D-F: on control PET ( D,E) and PET-CT (F), performed after three courses of chemotherapy, a significant decrease in FDG hypermetabolism in both mammary glands and vertebrae is determined.

PET-CT also plays a role in radiotherapy because it allows accurate assessment of tumor extent.

Tumor recurrence control

Early recognition of tumor recurrence is important in improving survival by prompting clinicians to use different treatment modalities. However, it is difficult to distinguish a true relapse from postoperative and radiation changes when using only traditional methods of radiation diagnosis. With limited, regional relapse, the mammary gland, skin, axillary and supraclavicular lymph nodes, and the chest wall are predominantly affected.

The sensitivity and specificity of PET in detecting recurrence were found to be 84% and 78%, respectively, while the sensitivity and specificity of conventional testing were 63% and 61%, respectively. PET has been suggested to be a more effective method for assessing breast cancer recurrence than traditional imaging techniques in detecting changes throughout the body. CT data obtained from PET-CT allow us to establish the correspondence of anatomical structures and foci of FDG hypermetabolism.

Local tumor recurrence in a 74-year-old woman who underwent a modified right radical mastectomy 8 years ago. A: Ultrasound revealed an ovoid-shaped mass, 1.4 cm, with increased blood flow, located in the right pectoral muscle in the mastectomy area. B, C: PET scan reveals a localized focus of FDG hypermetabolism (standardized uptake level = 3.3) (arrows) on the right side of the chest. D: PET-CT identifies a focus of FDG hypermetabolism (arrow) in the right pectoral muscle, while using PET alone is difficult to determine the exact location of the focus.

Deciphering PET-CT for breast cancer

In some cases, to increase the reliability of the assessment of PET-CT results, it is recommended to obtain a second opinion from a specialized radiologist. This may be necessary if the results of the initial reading of the images are dubious or ambiguous. A second opinion on PET-CT helps solve the following problems: reducing the risk of medical error, more reliable assessment of the primary tumor, clarifying the stage of the disease, reliably excluding signs of metastatic lesions of the bones, liver or lungs. In addition, as a result of such a consultation, the oncologist receives a more detailed description of the study, which helps him choose the most appropriate treatment protocol.

Conclusion

PET/CT plays an important role in the diagnosis of breast cancer, which consists of detecting and locating metastases, monitoring treatment and early detection of relapses. However, the limiting factor of PET/CT in detecting breast cancer is its lack of ability to detect small tumors.

Vasily Vishnyakov, radiologist

Materials used in preparing the text:

https://www.researchgate.net/publication/5920836_The_role_of_PETCT_for_evaluating_breast_cancer

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4665546/