Wk 3, Case 4 - Review

Please note: Items with dashed lines (--) are information withheld as it is not relevant for you to arrive at the correct findings and impression for the report and/or it was withheld for privacy information. The items were left in to show you the typical information documented in a PET report.

Clinical Indication:
Right breast triple negative poorly differentiated invasive ductal carcinoma, initial staging.

Technique:
Preparation: Last oral intake (except water) on --at --.
Diabetic: --.
Blood glucose at time of FDG administration: --- mg/dL.
Radiopharmaceutical: -- mCi of F-18 FDG administered IV at -- at --.
Incubation interval: -- minutes.
Oral contrast: --.
Positioning: Arms raised
PET/CT scanner: ---.
PET/CT acquisition: Vertex-to-midthigh.
PET reconstruction method: ---
Standardized uptake value (SUV): Corrected for body weight only.
CT: Low-dose, non-breath-hold, without intravenous contrast.
TOTAL DLP (Dose Length Product): -- mGy cm.

Comparison/Correlation:
No relevant prior imaging for comparison

Findings:
Technical quality: Diagnostic.
Measurements: Unless otherwise specified, all SUVs refer to maximum value in the target (mSUV) and all CT linear measurements are performed on axial images.

Reference: mean SUV liver: ----

Head and Neck:
No suspicious hypermetabolic activity in the head or neck.
No suspicious cervical adenopathy.


Breast:
Moderately hypermetabolic 19 x 12 mm mass within the upper outer quadrant of the right breast with a surgical clip and a maximum SUV 4.7, consistent with biopsy-proven invasive ductal carcinoma.
Multiple enlarged and intensely hypermetabolic metastatic right axillary, interpectoral, and subpectoral lymph nodes. For reference:

The largest interpectoral lymph node measures 1.5 cm with maximum SUV 12.8.
The largest right axillary lymph node measures 1.5 cm with maximum SUV 9.7.
Moderately hypermetabolic metastatic 7 x 5 mm right internal mammary lymph node maximum SUV 4.


Chest:
No suspicious metabolically active lesions within the chest.
No suspicious metabolically active or pathologically enlarged hilar or mediastinal adenopathy.
No suspicious pulmonary nodules or masses.
No pleural effusion, pericardial effusion or pneumothorax.
Left chest port with terminus in the right atrium.


Abdomen and Pelvis:
No suspicious hypermetabolic activity in the abdomen or pelvis.
Solid Abdominal Organs:
No focal hypermetabolic activity in the liver significantly greater than the heterogeneous physiologic uptake. Unremarkable noncontrast appearance of the liver.
Cholecystectomy.
No hydronephrosis.
Unremarkable spleen.
No suspicious adrenal masses.
No suspicious pancreatic findings.
GI Tract/Mesentery/Peritoneum:
Physiologic bowel activity, without suspicious focal FDG uptake. The large and small bowel appear normal in caliber.
No suspicious peritoneal/mesenteric findings.
Lymph Nodes: No pathologically enlarged or hypermetabolic lymph nodes in the abdomen or pelvis.
Pelvic Viscera: Bulky uterine fundus, possibly fibroid.
Vasculature: Normal caliber of the abdominal aorta.
Free Fluid: No ascites or drainable fluid collection.


Skeleton and Soft Tissues:
No suspicious metabolically active osseous or soft tissue lesions.
No aggressive lytic or sclerotic lesions.
Multilevel degenerative changes.

Impression:
1. Hypermetabolic mass in the upper outer quadrant of the right breast, consistent with biopsy proven invasive ductal carcinoma.
2. Multiple enlarged and hypermetabolic metastatic right axillary and internal mammary lymph nodes.
3. No convincing evidence of metabolically active distant metastatic disease.