PT  - JOURNAL ARTICLE
AU  - Cao, Qi
TI  - Rare bilateral pulmonary uptake on TC-99m MDP bone scan mimicking metastatic rib lesions in breast cancer
DP  - 2014 May 01
TA  - Journal of Nuclear Medicine
PG  - 1323--1323
VI  - 55
IP  - supplement 1
4099  - http://jnm.snmjournals.org/content/55/supplement_1/1323.short
4100  - http://jnm.snmjournals.org/content/55/supplement_1/1323.full
SO  - J Nucl Med2014 May 01; 55
AB  - 1323 Learning Objectives 1.To describe rare uptake of TC-99m MDP in non-osseous structures, such as metastatic lung lesions, that may mimic rib lesions, and 2. to discuss the impact of TC-99m MDP bone scan in the staging of breast cancer. Bone scintigraphy is widely used to detect bone metastasis owing to its high sensitivity. We report here a 64-year-old African American female who was initially diagnosed with stage II left breast infiltrating ductal carcinoma. She underwent radical mastectomy, axillary lymph node dissection and chemotherapy. The patient started to complain of increasing persistent hoarseness and dry cough. CT of the chest showed multiple bilateral pulmonary metastases. Fine needle aspiration of the lung mass showed moderately differentiated adenocarcinoma. CK7 strongly positive; CK20, TTF-1 and BRST2 are negative which are consistent with possible breast, pancreatic, biliary, or lung primary. Immunohistochemical staining revealed that the tumor is negative for estrogen and progesterone receptor, but positive for HER2/neu (IHC 3 plus). Screening mammogram showed indeterminate new nodule in the right breast. FDG PET/CT scans showed metastatic breast cancer confounded in the lungs with numerous metabolically active lung nodules, bilaterally. There was no evidence of metastatic disease in the brain, liver, lymph nodes or bones. Since bone scan has a low diagnostic yield in breast cancer patients with stage I and II disease, bone imaging is recommended only for those with stage 3 and 4 disease. Bone scans showed bilateral pulmonary uptake, mimicking metastatic rib lesions in a patient with breast cancer. Cases represented illustrate the calcification of metastatic breast lesion in the lungs on bone scan, with corresponding FDG PET/CT images distinguishing metabolically active metastatic lung lesions from a normal appearing rib cage.