case_images: PMC4337013_01
case_images: (a) Spot compression mammographic image of the right axilla of our patient shows a round hyperdense mass. (b) Ultrasound image of the right axilla shows an irregular, hypoechoic mass. On biopsy, this was found to be an invasive ductal carcinoma
case_images: WJNM-14-63-g001.jpg
case_images: PMC4337013_01_WJNM-14-63-g001.jpg
case_images: F1
case_images: A 67-year-old female presented to an outside hospital with a right axillary mass [Figures 1a and 1b].
case_images: Fused coronal PET-CT image of our patient before the axillary lymph node biopsy shows a lobulated FDG-avid mass (star) in the right axilla, which represents the patient's known axillary invasive ductal carcinoma. An adjacent small FDG-avid round structure (arrow) was suspicious for metastatic axillary lymphadenopathy
case_images: WJNM-14-63-g002.jpg
case_images: PMC4337013_01_WJNM-14-63-g002.jpg
case_images: F2
case_images: A whole-body PET-computed tomography (CT) scan performed thereafter showed a 1.7-cm mass with an SUV maximum of 5.9 in the right axilla, consistent with the patient's known malignancy, and an adjacent FDG-avid right axillary lymph node [Figure 2].
case_images: (a) PEM imaging of the right axillary tail shows the FDG-avid mass in the right axilla, which represents the patient's known invasive ductal carcinoma (IDC). Even with an approximate 37 MBq activity of 18F-FDG in the patient's system, the patient's carcinoma is well-visualized. (b) Another axillary tail postbiopsy PEM image of the right axilla shows the carcinoma (star) and the FDG-avid axillary lymph node (arrow). In comparison to the whole-body positron emission tomography-computed tomography image [Figure 2], the lymph node has changed in size and configuration, indirectly indicating correct biopsy sampling
case_images: WJNM-14-63-g003.jpg
case_images: PMC4337013_01_WJNM-14-63-g003.jpg
case_images: F3
case_images: PEM Flex Solo II, Naviscan) of the right axilla was then performed at 13:47 without administering more 18F-FDG. PEM imaging relied upon the remainder of the dose of 18F-FDG that the patient had received six hours earlier [Figure 3a]. FDG-avid right axillary lymph node had decreased in conspicuity after the biopsy in comparison to the pre-biopsy whole-body PET-CT, an indirect indication of successful biopsy sampling [Figure 3b]. Following PEM imaging of the right axilla, at approximately 14:50, the core biopsy samples were also examined with PEM imaging [Figures 4a and 4b], confirming activity within portions of the core biopsy samples.
case_images: (a) Photograph of the ultrasound core needle biopsy specimen positioned on the detector plate of the PEM scanner. (b) Corresponding PEM image of the of the specimen reveals FDG activity within the core samples, confirming successful sampling of the lymph node
case_images: WJNM-14-63-g004.jpg
case_images: PMC4337013_01_WJNM-14-63-g004.jpg
case_images: F4
case_images: FDG-avid right axillary lymph node had decreased in conspicuity after the biopsy in comparison to the pre-biopsy whole-body PET-CT, an indirect indication of successful biopsy sampling [Figure 3b]. Following PEM imaging of the right axilla, at approximately 14:50, the core biopsy samples were also examined with PEM imaging [Figures 4a and 4b], confirming activity within portions of the core biopsy samples.