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TUTORIAL: Clinical PET - Oncology
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Thorax
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Malignant tissue is characterized by a high rate of glycolysis; hence FDG is rapidly taken up by tumor cells. Large breast carcinoma lesions that are metabolically active have been proven to be visualized easily with conventional transaxial FDG-PET imaging, as shown in the above image (arrow). PET is also capable of detecting anatomically small metastases by virtue of their metabolic differences from surrounding normal tissue.
Reviewing the stack of whole-body image data in an interactive cine mode aids in the localization of the lesion relative to other organ structures. This method also provides a sensitive, non-invasive predictor of axillary lymph node involvement. The patient shown above had a large primary tumor and clinically palpable axillary lymph nodes. In the PET images, the breast lesion imaged as a focal area of increased glycolytic activity in the right breast. The center of the lesion is dark (planes 10-12) in comparison to the periphery, indicating a low glycolytic rate in this area consistent with necrosis. The right axillary lymph nodes are visible in a more posterior coronal view (planes 17-21, arrowhead). In a recent clinical trial (Tse, et al., 1992), PET was shown to have potential as a diagnostic modality for detection of primary breast cancer, particularly in patients with radiodense breasts by conventional mammography, and that it also has potential for preoperative identification of axillary lymph node metastases.
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This collage demonstrates how whole-body FDG imaging is useful for the detection of primary breast carcinoma as well as occult lymph node or systemic metastases. In addition, PET may permit physicians to follow the response of adjuvant chemotherapy, adjusting doses and drugs to achieve maximal response.
Credits
Material for this section was kindly provided by:Carl Hoh, M.D.
Dept. of Molecular and Medical Pharmacology
UCLA School of Medicine
Yong Choi, Ph.D.
Dept. of Radiology
University of Pittsburgh School of Medicine
Randall Hawkins, M.D., Ph.D.
Nuclear Medicine Division
UCSF School of Medicine
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