Nina Jehanno

The rate of distant metastases on FDG-PET/CT at initial staging of breast cancer: comparison between women younger and older than 40 years.

Women who have breast cancer and are younger than 40 y have a poorer outcome than older women. A higher rate of undetected metastases at the time of diagnosis in younger women has been proposed to account for this difference. Our main objective was to test this hypothesis by comparing the distant metastasis rate (DMR) on initial 18F-FDG PET/CT in a group of breast cancer patients younger than 40 y (<40 y group) with that in a group of breast cancer patients older than 40 y (≥40 y group). An assessment of associations between distant metastases and tumor characteristics was a second objective of the present study. Methods: A retrospective single-institution study was performed on women who had breast cancer and no prior malignancy, who were asymptomatic for metastatic lesions on initial clinical examination, and who had initial 18F-FDG PET/CT within 3 mo after pathologic breast cancer diagnosis and before initial treatment. On the basis of these criteria, data for 2 groups of women differing only in age (<40 y and ≥40 y) were extracted from the hospital information system of Curie Institute–Paris. 18F-FDG PET/CT examinations were reviewed, and the DMR was recorded for each clinical stage subgroup (stages I–III). Results: For each group (<40 y and ≥40 y), 107 patients were included, with the same number of patients in each clinical stage subgroup (12 stage I patients, 32 stage IIA patients, 30 stage IIB patients, and 33 stage III patients). The ages of the patients (mean ± SD) were 34.5 ± 4.0 y (<40 y group) and 56.0 ± 10.7 y (≥40 y group). No significant difference in DMRs was observed between the <40 y group and the ≥40 y group (DMRs, 21% and 22%, respectively; P = 1). The DMRs in patients not selected for age were 8% for stage I, 11% for stage IIA, 15% for stage IIB, and 44% for stage III. Conclusion: The DMR was not significantly higher in younger breast cancer patients (<40 y) than in older breast cancer patients (≥40 y), ruling out the assumption that undetected metastases at diagnosis explain the poorer outcome of younger women. However, our results highlight the high yield of 18F-FDG PET/CT for initial breast cancer staging, even in stage II patients, whatever their age.

PET/CT imaging in management of concomitant Hodgkin lymphoma and tuberculosis - a problem solver tool

Infectious lymph nodes mimicking lymphoma is challenging for accurate staging. Although 18F‐FDG is a nonspecific tracer accumulating not only in tumor cells but also in inflammatory tissues, the metabolic features and uptake kinetics give valuable information: 18F‐FDG PET/CT appears as a useful problem solver tool in ambiguous situation.

18F-FDG PET/CT findings in uterine leiomyomas.

A 43-year-old woman with a previous history of malignant melanoma of the lower limb was referred for F-FDG PET/ CT for suspected relapse after a routine CT scan revealed a ureterohydronephrosis. PET/CT revealed a large pelvic mass (a), containingmultiple extremely intense hypermetabolic nodular formations (b, c; SUVmax 23.5), compressing the right ureter. These formations presented with a hypometabolic centre suggesting fibrotic or necrotic remodelling. No abnormalities suggesting cutaneous or lymph node relapse were found. Pelvic MRI showed a uterus enlarged by multiple myometrial masses corresponding to the hypermetabolic nodular formations. These lesions were mildly hyperintense on T2-weighted images (d), enhanced after injection of gadolinium chelate (e), and were hypointense on diffusion-weighted images (f) suggesting highly cellular leiomyoma. However, the distinction between benign leiomyoma and malignant leiomyosarcoma on the basis of MRI features may be challenging [1].