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February 2023, Volume 73, Issue 2

IMAGING CORNER

18F-FDG PET-CT in Cutaneous Metastases in Breast Carcinoma: An unusual presentation

Myda Muzaffar  ( Department of Nuclear Medicine, Shaukat Khanum Memorial Cancer Hospital and Research Center Lahore, Pakistan )
Aamna Hassan  ( Department of Nuclear Medicine, Shaukat Khanum Memorial Cancer Hospital and Research Centre, Lahore, Pakistan )

Abstract

Cutaneous and subcutaneous metastases are an exceedingly rare presentation in various malignancies. These represent poor prognosis and disease progression. Early detection of such findings helps in changing the management plan. 18F-FDG PET–CT has played a key role in deciding treatment plan for patients with breast cancer, by detecting metastatic sites, with a high sensitivity in detecting cutaneous metastases as seen in the following case.

 

Keywords: 18F-FDG PET–CT, cutaneous, carcinoma, metastases

 

DOI: https://doi.org/10.47391/JPMA.14-23

 

Discussion

 

We present a case of a 57-year-old female with a left breast lump for 5 months. Tru-Cut biopsy revealed Ductal carcinoma in situ, micropapillary and comedo type with intermediate nuclear grade. The patient underwent neoadjuvant chemotherapy followed by left lateral Quadrantectomy with axillary lymph node dissection in 2016. She received radiotherapy to her left breast and left supraclavicular region in 2017. Subsequently tamoxifen was started, and the patient was kept on follow-up. Bone scan in 2019 showed interval development of osteoblastic skeletal metastases. CT (Computed Tomography) chest, abdomen and pelvis showing bilateral pulmonary nodules. On subsequent imaging in September 2020, there was an increase in pulmonary nodules and interval development of right adrenal lesion. Capecetabine was commenced and restaging CT scan in January 2021 showed nodular left breast mass, raising concern for local disease recurrence. Restaging 18F-Fluorodeoxyglucose Positron Emission Computed tomography - Computed Tomography (18F-FDG PET–CT scan) revealed hypermetabolic cutaneous metastases along with FDG avid left breast mass and pulmonary, adrenal, and osseous metastases (Figure); suggestive of disease progression.

 

 

18F-FDG PET–CT has a proven role in the staging and restaging of various cancers thereby playing a key role in patient management.1 In patients with breast cancer, the most important clinical application of 18F-FDG PET–CT is detecting recurrent and/or metastatic disease, and monitoring response.2

Cutaneous metastases from malignancies are exceedingly rare with an incidence of 0.7% to 10%3 most seen in breast cancer.4 18F-FDG PET–CT has a vital role with higher sensitivity for cutaneous and soft tissue metastases which can easily be missed on conventional imaging.5

 

References

 

1.      Almuhaideb A, Papathanasiou N, Bomanji J. 18F-FDG PET/CT imaging in oncology. Ann Saudi Med. 2011;31:3-13. doi:10.4103/0256-4947.75771

2.      Eubank WB, Mankoff DA. Evolving role of positron emission tomography in breast cancer imaging. Semin Nucl Med. 2005;35:84–99.

3.      G Nava, K Greer, J Patterson, KY Lin. Metastatic cutaneous breast carcinoma: A case report and review of the literature. Can J Plast Surg 2009;17:25-27.

4.      Manohar K, Mittal BR, Bhattacharya A, Singh G. Asymptomatic Distant Subcutaneous Metastases Detected by (18)F-FDG-PET/CT in a Patient with Breast Carcinoma. World J Nucl Med 2012;11:24-25.

5.      Tamam M, Vural O, EkmeKci TR, Kamali G, Mulazimoglu M. Detection of Isolated Diffuse Cutaneous and Subcutaneous Metastasis of Breast  Cancer on FDG-PET/CT. Molecular Imaging and Radionuclide Therapy 2015;24 (Supplement 1): 4-6

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