Nilüfer BIÇAKÇI, Fevziye TOSUN CANBAZ, Tarık BAŞOĞLU, Evrim BAYMAN

Meme kanserinin progresif osteoblastik metastazlarında yalancı negatif F-18 FDG PET bulguları

Meme kanserinin radyolojik takibinde kemikte yeni saptanan hiperdens lezyonlar, “sıklıkla başlangıçta gözden kaçan/görüntülenemeyen ve tedavi sonrasında sklerotik karakter alan, blastik tranformasyon geçirmiş inaktif osteolitik lezyonlar” olarak yorumlanabilmektedir. Ancak bu tip lezyonlar içerisinde olası osteoblastik metastazların F-18 FDG-PET/BT ile saptanamamış olması, yanlış-negatifliğin yanı sıra, tedaviye daha iyi yanıt verebildiği bildirilen, FDG açlığı olmayan, osteoblastik metastazların atlanması riskini de taşımaktadır. Bu olguda, ilk tanısı T3N2M0 olan 41 yaşında bir bayan hasta sunulmaktadır. Hastada cerrahi, radyoterapi (RT) ve kemoterapi’den (KT) bir yıl sonra kemik ağrısı olması ve serum tümör belirteçlerinin yükselmesine karşın F-18 FDG-PET/BT incelemesinde, kemik sintigrafisinde progresyon saptanan osteoblastik lezyonlarda patolojik FDG aktivitesi izlenmemesi tartışılmaktadır. Meme kanserinde F-18 FDG-PET/BT çalışmalarını rutin olarak “litik lezyon” tabanlı olarak yorumlama eğilimi kanımızca riskli bir yaklaşımdır. Sunulan olguda F-18 FDG bulgularının, Tc99m MDP bulguları ile karşılaştırmalı olarak değerlendirmenin önemi vurgulanmaktadır.

False negative F-18 FDG PET findings in progressive osteoblastic metastases of the breast cancer

New hyperdense lesions during radiological follow-up of breast cancer are frequently interpreted as “initially overlooked/unvisualized sclerotic and inactive lesions, which probably have undergone blastic transformation following therapy”. However, overlooking osteoblastic metastases on F-18 FDG-PET/CT among such lesions includes, besides false-negativity, the risk of missing non-FDG-avid osteoblastic metastases, which are reported to be even more responsive to therapy. Here, a 41-year-old woman with an initial diagnosis of T3N2M0 is presented. One year after surgery, radiotherapy (RT), and chemotherapy (CT), the patient was referred with bone pain and elevation of tumor markers. Multiple progressive osteoblastic metastases, detected on the bone scan were found to be F-18-FDG-PET - negative was discussed. The tendency towards “lytic lesion based” interpretation of the F-18 FDG-PET/CT studies in breast cancer patients might be, in our opinion, a risky approach. In the presented case, the importance of lesion-to-lesion comparison of F-18 FDG PET and Tc99m-MDP bone scintigraphy is emphasized.

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1. Newcomb PA, Lantz PM. Recent trends in breastcancer incidence, mortality, and mammography. Breast Cancer Res Treat 1993;28(2):97-106.
2. Wahl RL, Cody RL, Hutchins GD, et al. Primary and metastatic breast carsinoma: initial clinical evaluation with PET with the radiolabeled glucose analogue 2-(F-18)- fluoro-2-deoxy-Dglucose. Radiology 1991;179:765-70.
3. Avril N, Dose J, Janicke F, et al. Assesment of axillary lymph node involvement in breast cancer patients with positron emission tomography using radiolabeled 2-(flurine-18)-fluoro-2- deoxy- D-glucose. J Nath Cancer Inst 1996; 88:1204-9.
4. Hok CK, Hawking RA, Glaspy JA, et al. Cancer dedection with whole-body PET using 2- (18F)-fluoro-2-deoxy-D-glucose. J Comput Assist Tomogr 1993;17:582-9.
5. Cook GJ, Houston S, Rubens R, et al. Detection of bone metastases in breast cancer by 18 FDG PET: differing metabolic activity in osteoblastic and osteolytic lesions. J Clin Oncol 1998; 16(10):3375-9.
6. Abe K, Sasaki M, Kuvabara Y, et al. Comparison of 18 FDG-PET with 99mTc-HMDP scintigraphy fort he dedection of bone metastases in patients with breast cancer. Ann Nucl Med 2005;19:573-9.
7. Galasko CS. Mechanisms of lytic and blastic metastatic disease of bone. Clin Orthop 1982;169:20-7.
8. Nakai T, Okuyama C, Kubota T, et al. Pitfalls of FDG-PET for the diagnosis of osteoblastic bone metastases in patients with breast cancer. Eur J Nucl Med Mol Imaging 2005;32:1253-8.
9. Uematsu T, Yuen S, Yukisawa S, et al. Comparison of FDG PET and SPECT for detection of bone metastases in breast cancer. AJR Am J Roentgenol.2005;184:1266- 73.
10. Israel O, Goldberg A, Nachtigal A, et al. FDGPET and CT patterns of bone metastases and their relationship to previously administered anti-cancer therapy. Eur J Nucl Med Mol Imaging 2006;33:1280-4.
11. Du Y, Cullum I, Illidge TM, et al. Fusion of
metabolic function and morphology: sequential -18F- fluorodeoxyglucose positron-emission tomography/computed tomography studies yield new insights into the natural history of bone metastases in breast cancer. J Clin Oncol 2007;25:3440-7.
12. Coleman RE, Mashiter G, Whitaker K B, Moss D W, Rubens RD, Fogelman I. Bone scan flare predicts successful systemic therapy for bone metastases. J Nucl Med 1988;29:1354- 9.
13. Alexander J L, Gillespie P J, Edelstyn G A Serial bone scanning using technetium 99m diphosphonate in patients undergoing cyclical combination chemotherapy for advanced breast cancer. Clin Nucl Med 1976;1:13-6.
14. Huyge V, Garsia C, Vanderstappen A, Alexiou J, Gil T and Flamen P. Progressive osteoblastic bone metastases in breast cancer negative on FDG-PET. Clin Nucl Med 2009; 34:417-20.

Turkish Journal of Nuclear Medicine (. Molecular Imaging and Radionuclide Therapy)-Cover

ISSN: 1304-1495
Yayın Aralığı: Yılda 4 Sayı
Başlangıç: 1992
Yayıncı: Ortadoğu Reklam Tanıtım Yayıncılık Turizm Eğitim İnşaat Sanayi ve Ticaret A.Ş.