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Paradoxal metabolic flare detected by 18F-fluorodeoxyglucose positron emission tomography in a patient with metastatic breast cancer treated with aromatase inhibitor and biphosphonate.

D'Amico A, Kowalska T - Indian J Nucl Med (2014)

Bottom Line: We describe a case of a patient with invasive ductal breast cancer with bone metastases at bone scintigraphy and FDG PET scan and with expression of estrogen receptors.Owing to progression observed in a bone scan, Tamoxifen was substituted with aromatase inhibitors.Successive bone scan examinations showed stabilization with a marked clinical improvement.

View Article: PubMed Central - PubMed

Affiliation: Department of Diagnostic PET, Maria Skłodowska-Curie Memorial Cancer Center and Institute of Oncology, Gliwice, Poland.

ABSTRACT
Patients with estrogen-receptor-positive advanced breast cancer are treated with endocrine therapy. The majority of breast cancer localizations show 18F-fluorodeoxyglucose (FDG) uptake at positron emission tomography (PET) examination. In these patients, the metabolic flare after therapy is common and was proposed as an index of therapy efficacy. Nevertheless, prolonged persistence of flare can lead to misinterpretation. We describe a case of a patient with invasive ductal breast cancer with bone metastases at bone scintigraphy and FDG PET scan and with expression of estrogen receptors. Initially, the patient underwent endocrine therapy in addition to a biphosfonate. Owing to progression observed in a bone scan, Tamoxifen was substituted with aromatase inhibitors. Successive bone scan examinations showed stabilization with a marked clinical improvement. A second FDG PET was performed 28 months after the first examination and showed a metabolic flare phenomenon with concomitant partial calcification of osteolitic lesions. This is an unusual case of prolonged metabolic flare.

No MeSH data available.


Related in: MedlinePlus

Fused images of costal lesion at first (c) and second (d) positron emission tomography-computed tomography examination, showing 18F-fluorodeoxyglucose uptake increase concomitant to recalcification
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Figure 5: Fused images of costal lesion at first (c) and second (d) positron emission tomography-computed tomography examination, showing 18F-fluorodeoxyglucose uptake increase concomitant to recalcification

Mentions: Another FDG PET examination was performed on February 8, 2013 for a complexive evaluation of the regression degree, 22 and 31 months after the beginning of therapies with the aromatase inhibitor and biphosphonate respectively. The scan was ruled out with the use of a Siemens mCT device, 1 h after an injection of 240 MBq of FDG. Evident recalcification of bone lesions was seen on computed tomography (CT), while an increase of FDG uptake was clearly observable for almost all the bone lesions [Figures 2b, 3 and 4]. A direct comparison between SUV scores was not possible, because of PET scans having been performed by different devices. However, tumor/background ratios between physiological liver uptake and pathologic FDG accumulation displayed on Figures 3b (V right rib) and 4b (sternum) confirmed the visual impression of increased radiofarmaceutical uptake [Table 1].


Paradoxal metabolic flare detected by 18F-fluorodeoxyglucose positron emission tomography in a patient with metastatic breast cancer treated with aromatase inhibitor and biphosphonate.

D'Amico A, Kowalska T - Indian J Nucl Med (2014)

Fused images of costal lesion at first (c) and second (d) positron emission tomography-computed tomography examination, showing 18F-fluorodeoxyglucose uptake increase concomitant to recalcification
© Copyright Policy - open-access
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC3928749&req=5

Figure 5: Fused images of costal lesion at first (c) and second (d) positron emission tomography-computed tomography examination, showing 18F-fluorodeoxyglucose uptake increase concomitant to recalcification
Mentions: Another FDG PET examination was performed on February 8, 2013 for a complexive evaluation of the regression degree, 22 and 31 months after the beginning of therapies with the aromatase inhibitor and biphosphonate respectively. The scan was ruled out with the use of a Siemens mCT device, 1 h after an injection of 240 MBq of FDG. Evident recalcification of bone lesions was seen on computed tomography (CT), while an increase of FDG uptake was clearly observable for almost all the bone lesions [Figures 2b, 3 and 4]. A direct comparison between SUV scores was not possible, because of PET scans having been performed by different devices. However, tumor/background ratios between physiological liver uptake and pathologic FDG accumulation displayed on Figures 3b (V right rib) and 4b (sternum) confirmed the visual impression of increased radiofarmaceutical uptake [Table 1].

Bottom Line: We describe a case of a patient with invasive ductal breast cancer with bone metastases at bone scintigraphy and FDG PET scan and with expression of estrogen receptors.Owing to progression observed in a bone scan, Tamoxifen was substituted with aromatase inhibitors.Successive bone scan examinations showed stabilization with a marked clinical improvement.

View Article: PubMed Central - PubMed

Affiliation: Department of Diagnostic PET, Maria Skłodowska-Curie Memorial Cancer Center and Institute of Oncology, Gliwice, Poland.

ABSTRACT
Patients with estrogen-receptor-positive advanced breast cancer are treated with endocrine therapy. The majority of breast cancer localizations show 18F-fluorodeoxyglucose (FDG) uptake at positron emission tomography (PET) examination. In these patients, the metabolic flare after therapy is common and was proposed as an index of therapy efficacy. Nevertheless, prolonged persistence of flare can lead to misinterpretation. We describe a case of a patient with invasive ductal breast cancer with bone metastases at bone scintigraphy and FDG PET scan and with expression of estrogen receptors. Initially, the patient underwent endocrine therapy in addition to a biphosfonate. Owing to progression observed in a bone scan, Tamoxifen was substituted with aromatase inhibitors. Successive bone scan examinations showed stabilization with a marked clinical improvement. A second FDG PET was performed 28 months after the first examination and showed a metabolic flare phenomenon with concomitant partial calcification of osteolitic lesions. This is an unusual case of prolonged metabolic flare.

No MeSH data available.


Related in: MedlinePlus