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Confusing PET/CT results

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    Posted: Feb 12 2020 at 8:52am
I am a 2-time TNBC survivor (2008 & 2013 separate primary tumors-underwent mastectomies and chemo). 3 months ago PET/CT detected suspicious nodes left underarm, underwent biopsy-results benign. Underwent another PET/CT this week-more nodes showed up and previous ones grew. Doctor is ordering 3 more biopsies for suspicious nodes. Unfortunately, I only spoke with a nurse and she couldn't answer my detailed questions. I have Lupus and the breast oncologist previously thought that the inflammation of nodes was a result of an active flare. I am concerned about the subpectoral nodes because those have NEVER lit up before.

Here are my results:

"There is interval increase in size and number of FDG avid lymph nodes in the left subpectoral region/left axilla. Biopsied left subpectoral lymph node with a biopsy clip measures 1.4 x 1 cm demonstrating FDG uptake with max SUV of 3.2. Additional left subpectoral/axillary lymph node seen on image 76 series 5 more posteriorly and superiorly measures 1.3 x 0.9 cm demonstrating FDG uptake with max SUV of 2.7. A

1.5 x 0.6 cm subpectoral lymph node seen on image 74 series 5 also demonstrates FDG uptake which is less than background, is suspicious as it is increased from previous. 3 other subcentimeter left axillary lymph nodes and 1 additional subpectoral lymph nodes demonstrate low level FDG activity new since previous."

QUESTION:

Has anyone had these kind of results that results in a positive malignancy outcome or not? I know that no one can predict outcomes, but I am just curious.
6/26/08 DX TNBC, Grade III, Stage II, 0/17 nodes, KI-67 80%, BRCA-,R-mx&recon 7/08. 8/2012 mammo NED, 6/2013 DX New primary TNBC tumor L-mx&recon. Age 38
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Post Options Post Options   Thanks (0) Thanks(0)   Quote 123Donna Quote  Post ReplyReply Direct Link To This Post Posted: Feb 13 2020 at 8:23am
In 2010 I had a routine PET scan that found a suspicious area.  The SUV was 1.5 and we were hoping it wasn't cancer.  My onc ordered an MRI that identified the area as an internal mammary node.  Subsequently I had to have a needle biopsy that confirmed it was a recurrence.  I'm hoping your results are just because of inflammation and not cancer.  Keep us posted on what you find out.  Hugs.

Donna
DX IDC TNBC 6/09 age 49, Stage 1,Grade 3, 1.5cm,0/5Nodes,KI-67 48%,BRCA-,6/09bi-mx, recon, T/C X4(9/09)
11/10 Recur IM node, Gem,Carb,Iniparib 12/10,MRI NED 2/11,IMRT Radsx40,CT NED11/13,MRI NED3/15

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Post Options Post Options   Thanks (0) Thanks(0)   Quote acceptinglife Quote  Post ReplyReply Direct Link To This Post Posted: Feb 13 2020 at 12:24pm
Thank you for your response Donna. That SUV, at 1.5, is not very much at all. I am surprised. If my biopsies do come back positive, I will just be thankful that now I know and can move forward treating them.

6/26/08 DX TNBC, Grade III, Stage II, 0/17 nodes, KI-67 80%, BRCA-,R-mx&recon 7/08. 8/2012 mammo NED, 6/2013 DX New primary TNBC tumor L-mx&recon. Age 38
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Post Options Post Options   Thanks (0) Thanks(0)   Quote 123Donna Quote  Post ReplyReply Direct Link To This Post Posted: Feb 13 2020 at 6:38pm
Knowledge is power and you have a good attitude.  I always found the unknown/uncertainty was the hardest part.  Were you tested for other gene mutations besides the BRCA test?  They are finding many more genes associated with breast cancer than just the BRCA gene.  Please let us know what they find.  We are here for you and hope you get good news that it's benign.

Donna
DX IDC TNBC 6/09 age 49, Stage 1,Grade 3, 1.5cm,0/5Nodes,KI-67 48%,BRCA-,6/09bi-mx, recon, T/C X4(9/09)
11/10 Recur IM node, Gem,Carb,Iniparib 12/10,MRI NED 2/11,IMRT Radsx40,CT NED11/13,MRI NED3/15

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Post Options Post Options   Thanks (0) Thanks(0)   Quote lavi Quote  Post ReplyReply Direct Link To This Post Posted: Jul 21 2020 at 12:06pm
Hi Donna, 
I'm trying to ask a question as a result of a post of yours: you said that in 2010 PET has identify something of 1.5 and  that was an cancerous IM node. Do you mean 1.5 cm?
I also send you a private message
Thank you, Lavinia
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Post Options Post Options   Thanks (1) Thanks(1)   Quote 123Donna Quote  Post ReplyReply Direct Link To This Post Posted: Jul 21 2020 at 10:31pm
Hi Lavinia,

The standard uptake value (SUV), also known as standardized uptake value, is a simple way of determining activity in PET imaging, most commonly used in fluorodeoxyglucose (FDG) imaging. It is also known as the dose uptake ratio (DUR). 

PET scans gives results in SUV’s.  Usually anything over 2.0 - 2.5 is considered malignant.  If it’s under that number, it may be benign.  

Positron Emission Tomography
Typically, a standardized uptake value (SUV), a quantity that incorporates the patient's size and the injected dose, that is more than 2.0 is considered to be suggestive of malignancy, whereas lesions with SUVs less than this value are considered to be benign.

You said in my post the SUV was 1.5.  This was the uptake of the FDG they inject prior to the scan.  While it was below the 2.0/2.5 SUV level for malignancy, it was suspicious for malignancy and required further testing for me (MRI, then needle biopsy).  I was hoping that it was benign, but it wasn’t.  

Donna
DX IDC TNBC 6/09 age 49, Stage 1,Grade 3, 1.5cm,0/5Nodes,KI-67 48%,BRCA-,6/09bi-mx, recon, T/C X4(9/09)
11/10 Recur IM node, Gem,Carb,Iniparib 12/10,MRI NED 2/11,IMRT Radsx40,CT NED11/13,MRI NED3/15

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Post Options Post Options   Thanks (0) Thanks(0)   Quote lavi Quote  Post ReplyReply Direct Link To This Post Posted: Jul 22 2020 at 4:19pm
Thank you very much Donna, like always you are helping so much.
Lavinia
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