title: Two cases of occult breast cancer in which PET-CT was helpful in identifying primary tumors.
abstract: We report two cases of occult breast cancer in which masses were completely nonpalpable and positron emission tomography-computed tomography (PET-CT) was extremely helpful in identifying the primary tumor. Case 1 involved a 56-year-old woman with enlarged lymph nodes 3 cm in size in the axilla. Based on excisional biopsy, axillary lymph node metastasis of breast cancer was suspected but an obvious primary tumor in the breast was not identifiable on mammography, contrast-enhanced CT, or ultrasonography. Faint accumulation of fluorodeoxyglucose (FDG) was noted only on PET-CT, so the site was considered to be the primary site, and operation was performed. As a result of postoperative pathological examination, ductal carcinoma in-situ (DCIS) was diagnosed. Case 2 involved a 55-year-old woman with enlarged lymph nodes 3 cm in size in the axilla. Based on the excisional biopsy, axillary lymph node metastasis of breast cancer was suspected. In this case as well, an obvious primary tumor was not identifiable with palpation or mammography. On PET-CT, faint accumulation of FDG was noted in the vicinity of the CD regions, or upper and lower outer quadrants. When contrast-enhanced CT and ultrasonography were performed, a faint nodular opacity less than 1 cm in size corresponding to this site was found and diagnosed as the primary site, operation was subsequently performed. Pathologic diagnosis indicated invasive cancer. PET-CT is a helpful option for the diagnosis of occult breast cancer with primary sites that conventional imaging studies have difficulty identifying.
authors.affiliation: Department of Breast Oncology, National Hospital Organization, National Shikoku Cancer Center, 160 Ko, Minamiumemoto, Matsuyama, Ehime, 791-0280, Japan. dtakabat@shikoku-cc.go.jp
authors.forename: Daisuke
authors.initials: D
authors.lastname: Takabatake
authors.forename: Naruto
authors.initials: N
authors.lastname: Taira
authors.forename: Kenjiro
authors.initials: K
authors.lastname: Aogi
authors.forename: Shozo
authors.initials: S
authors.lastname: Ohsumi
authors.forename: Shigemitsu
authors.initials: S
authors.lastname: Takashima
authors.forename: Takeshi
authors.initials: T
authors.lastname: Inoue
authors.forename: Rieko
authors.initials: R
authors.lastname: Nishimura
mesh_terms: D001943:Breast Neoplasms / Q000175:diagnosis*; D005260:Female; D019788:Fluorodeoxyglucose F18; D006801:Humans; D008198:Lymph Nodes / Q000000981:diagnostic imaging; D008207:Lymphatic Metastasis / Q000175:diagnosis; D008327:Mammography; D008875:Middle Aged; D009367:Neoplasm Staging; D049268:Positron-Emission Tomography; D019275:Radiopharmaceuticals; D014057:Tomography, X-Ray Computed
chemical_list: D019275:Radiopharmaceuticals; D019788:Fluorodeoxyglucose F18