Contribution of 18F-FDG PET/CT in occult breast carcinoma

Early detection of primary lesion with isolated axillary lymph node metastasis without any clinical or radiological evidence of tumour is still a pending issue. It is important to offer these patients a better management and survival. The definition of occult breast carcinoma is redefined as radiological diagnostic techniques progress. We emphasize the contribution of whole-body fluorine-18 fluorodeoxyglucose positron emission tomography associated with computed tomography for staging, surgical approach and adjuvant treatments recommendations for these patients.

Atypical axillary lymphadenopathy mimicking an occult breast carcinoma in a patient diagnosed with sarcoidosis: case report

Introduction: Occult breast carcinoma is a rare presentation of breast cancer, with histological evidence of axillary lymph node involvement and clinical and radiological absence of malignant breast lesions. Its survival is similar to that of the usual presentation. The treatment consists of modified radical mastectomy or axillary drainage with breast irradiation, resulting in similar survival, associated with systemic therapy according to the staging. Neoadjuvant therapy should be considered in N2-3 axillary cases. Differential diagnoses of axillary lymphadenopathies include: non-granulomatous causes (reactive, lymphoma, metastatic carcinoma) and granulomatous causes (infectious – toxoplasmosis, tuberculosis, sarcoidosis, atypical mycobacteria). Objectives: To report the case of a patient who needed a differential diagnosis among the various causes of axillary lymphadenopathy. Methods: This is a literature review conducted in the PubMed database, using the keywords "granulomatous lymphadenitis", "breast sarcoidosis", "occult breast cancer". Inclusion and exclusion criteria were applied. Case report: V.F.S., female, 51 years old, was referred to an evaluation of axillary lymphadenopathy in May 2019. She was followed by the department of pulmonology due to mediastinal sarcoidosis since 2017. Physical examination indicated breasts without changes. Axillary lymph nodes had increased volume and were mobile and fibroelastic. Mammography revealed only axillary lymph nodes with bilaterally increased density, and the ultrasound showed the presence of atypical bilateral lymph nodes. Neither presented breast lesions. Axillary lymph node core biopsy was compatible with granulomatous lymphadenitis. This result corroborates the diagnosis of sarcoidosis affecting peripheral lymph nodes. The patient was referred back to the department of pulmonology, with no specific treatment since she is oligosymptomatic. Discussion: Despite the context of benign granulomatous disease, malignancy overlying the condition of sarcoidosis must be ruled out. The biopsy provided a safe and definitive diagnosis, excluding the possibility of occult breast carcinoma. The patient will continue to undergo breast cancer screening as indicated for her age and usual risk. Conclusion: In the presentation of axillary lymphadenopathy, the mastologist must know the various diagnoses to be considered. The most feared include lymphoma and carcinoma metastasis with occult primary site. A proper workup can determine the diagnosis and guide the appropriate treatment.

Comparison between Mammography and Breast Ultrasound in the Detection of Breast Cancer in Dense Breast Tissue among a Sample of Iraqi Women

Background: Breast cancer is the most common cancer reported in women worldwide . In Iraq, it is the most common registered malignancy. Mammography plays a major role in the early detection of breast cancers. Dense breast parenchyma has been reported to be the most important inherent factor that limits depiction of breast cancer on mammogram, and often needs supplementary breast ultrasound for complete assessment. Objectives: To evaluate and compare the diagnostic performance of mammography and ultrasound in the detection of breast cancer in dense breast tissue. Patients and methods: A record review study was performed in the Oncology Teaching Hospital/ Medical City from April 2018 to December 2018. The study included forty five females, who attended the Main Referral Center for Early Detection of Breast Tumors during 2017 and 2018 were diagnosed with breast cancer histopathologically . They had dense breast tissues on mammography (either heterogeneously dense breast tissue i.e . category C or extremely dense breast tissue i.e. category D). All patients underwent subsequent breast ultrasound . Their information including the mammogram findings, breast ultrasound, fine needle aspiration (FNA) and biopsy results were reviewed analyzed and compared. Results:Twenty four patients (53.3%) had heterogeneously dense breast tissue (ACR category C) and 21 patients (46.6%) had extremely dense breast tissue (ACR category D). The mammogram detected 36 from 45 breast cancers (80%) while 9 (20%) were not detected by mammogram, so the mammogram had a detection rate of breast cancer of 80% in mammographically dense breast, while breast ultrasound had higher detection rate of about 97.7% .The sensitivity of mammography in extremely dense breast tissue was about 71% and in heterogeneously dense breast was about 87% while ultrasound had shown a higher sensitivity with increasing tissue density (98% vs. 100%). Conclusion: Breast cancer can be easily obscured and missed in mammographically dense breast tissue due to overlapping surrounding fibroglandular tissue and additional complementary breast ultrasound is highly recommended for a thorough evaluation and to depict mammographically occult breast carcinoma.