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Park, Cho, Park, Seo, Woo, Song, Oh, and Bae: Utility of Second-Look Examinations in the Management of a New Hypermetabolic Lesion Detected by Fluorodeoxyglucose Positron Emission Tomography/CT for Diagnosis of Loco-Regional Recurrence in Patients with Breast Cancer
Breast Radiology

Journal of the Korean Society of Radiology 2014; 70(2): 145-152.

Published online: 17 February 2014

DOI: https://doi.org/10.3348/jksr.2014.70.2.145

Utility of Second-Look Examinations in the Management of a New Hypermetabolic Lesion Detected by Fluorodeoxyglucose Positron Emission Tomography/CT for Diagnosis of Loco-Regional Recurrence in Patients with Breast Cancer

Jinyoung Park, MD1, Kyu Ran Cho, MD1, Eun Kyung Park, MD1, Bo Kyoung Seo, MD1, Ok Hee Woo, MD1, Sung Eun Song, MD1, Yu Whan Oh, MD1, Jeong Won Bae, MD2

1Department of Radiology, Korea University College of Medicine, Seoul, Korea.

2Department of Surgery, Korea University College of Medicine, Seoul, Korea.

Corresponding author: Kyu Ran Cho, MD. Department of Radiology, Korea University Anam Hospital, Korea University College of Medicine, 73 Inchon-ro, Seongbuk-gu, Seoul 136-705, Korea. Tel. 82-2-920-5657, Fax. 82-2-929-3796, krcho@korea.ac.kr

Received 17 September 2013       Accepted 25 October 2013

Copyright © 2014 The Korean Society of Radiology

(open-access):

This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/3.0/) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.

Abstract

Purpose

To investigate the clinical significance of a new hypermetabolic lesion detected by fluorodeoxyglucose positron emission tomography/CT (FDG-PET/CT) as well as the utility of second-look examinations to evaluate loco-regional recurrence of breast cancer.

Materials and Methods

Our database revealed 922 breast cancer patients who underwent surgery from January 2008 to July 2011. We included 20 patients with negative findings on routine follow-up but with new hypermetabolic lesions on FDG-PET/CT. All underwent second-look examination [breast ultrasound (US) = 14, chest CT scan = 6]. A total of 17 cases were pathologically verified and 3 were diagnosed with follow-up imaging.

Results

The locations were in the axillae (n = 7), breast (n = 6), chest wall (n = 3), cervical/supraclavicular (n = 3), and internal mammary (n = 1). Of the 20 hypermetabolic lesions, 10 were pathologically confirmed malignancies. Of the 14 patients who had undergone US, 7 had suspicious findings and 5 were confirmed as malignancies. Of a total of 6 patients who had undergone CT scans, 5 had suspicious findings and all turned out to be malignancies. The positive predictive value of the second-look examination was 83.3% (10/12).

Conclusion

Second-look examination and pathologic confirmation should be performed for newly appearing hypermetabolic lesions on FDG-PET/CT in order to exclude loco-regional recurrence in breast cancer patients.

Keywords: Breast Cancer, Fluorodeoxyglucose Positron Emission Tomography/CT, Recurrence, Second-Look Ultrasound

Figures and Tables

Fig. 1
A 30-year-old woman who had undergone left modified radical mastectomy for mucinous carcinoma presented with a lesion suspicious for malignancy on a 3-year follow-up fluorodeoxyglucose positron emission tomography (FDG-PET)/CT scan and confirmed as local recurrences on pathologic examination.
A. FDG-PET/CT scan shows multifocal hypermetabolic nodular lesions in left axilla, pectoralis muscle, shoulder, and brachialis muscle (arrows).
B. Second-look ultrasound shows multiple partially indistinct isoechoic masses (arrow) at the corresponding areas and these are considered to be BI-RADS category 5.
jksr-70-145-g001
Fig. 2
A 54-year-old woman who had undergone left modified radical mastectomy presented with a lesion suspicious for malignancy on a 4.5-year follow-up fluorodeoxyglucose positron emission tomography (FDG-PET)/CT scan but confirmed as benign reactive hyperplasia on pathologic specimen.
A. FDG-PET/CT scan shows a newly developed hypermetabolic lesion in the right axilla (arrow) which is suspicious for metastatic lymphadenopathy.
B. Second-look ultrasound shows a hypoechoic lymph node (arrow) in the right axilla. It shows eccentric cortical thickening, and so is considered to be a malignant lymph node (BI-RADS category 4a).
jksr-70-145-g002
Fig. 3
A 67-year-old woman who underwent left modified radical mastectomy presented with a lesion concerning for malignancy on a 3 year 2 months follow-up fluorodeoxyglucose positron emission tomography (FDG-PET)/CT scan and confirmed to be a malignant lymph node on final pathologic examination.
A. FDG-PET/CT scan shows a focal hypermetabolic nodule (arrow) in the left internal mammary area.
B. Second-look chest CT scan shows a 0.5-cm enhancing nodular lesion (arrow) in the left internal mammary area. This is very small but not seen on previous imaging so considered to be a malignant lesion (BI-RADS category 4c).
jksr-70-145-g003
Fig. 4
Hypermetabolic lesions detected by fluorodeoxyglucose positron emission tomography/CT correlated with second-look imaging and pathologic findings. The overall sensitivity, specificity, positive predictive values, and negative predictive values of second-look examination are 100% (10/10), 80% (8/10), 83.3% (10/12), and 100% (8/8).
jksr-70-145-g004

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