Imaging plays a vital role in the staging and restaging of breast cancer. Traditionally, chest X-ray, bone scintigraphy and liver ultrasound or computed tomography are used.1 Fluorine-18 fluorodeoxyglucose (F-18 FDG) positron emission tomography/computed tomography (PET/CT) has great potential for whole-body staging with a single procedure. The greatest utility of PET/CT lies in distant or M-staging, whereas its role in locoregional staging is generally considered to be complementary to other modalities.2,3 We present details of a 48-year-old woman with breast carcinoma, clinically staged as a T3N2 lesion. Initial ultrasonography showed a liver lesion with an equivocal appearance. A F-18 FDG PET/CT scan was then performed. It showed a left breast mass with two pathological axillary lymph nodes. The breast tumour and lymph nodes were associated with intense FDG-activity. A hypodense liver lesion with absent FDG activity was noted, consistent with a haemangioma (not shown). With the pelvic images, a myomatous uterus was seen with a small mass right postero- lateral to the uterus. The mass measured 19 mm x 14 mm, with a density of 80 Hounsfield units and increased metabolic activity. After review, the differential diagnosis was finally proposed as follows: primary ovarian lesion, pedunculated uterine myoma with sarcomatous degeneration and an ovarian metastasis. A hysterectomy with bilateral salpingo-oophorectomy was performed. Metastatic breast carcinoma was seen in the ovary with Staging of breast cancer with PET/CT J S Möller, FCNP (SA) W H Pieterse, M Med (Rad D) P D du Toit, M Med Sc Free State PET/CT Centre, Bloemfontein S Bonnet, M Med (Rad T) A Diedericks, FCOG (SA) W Brummer, M Med (Anat Path) Bloemfontein Medi-Clinic 75 SA JOURNAL OF RADIOLOGY • October 2008 PICTORIAL ESSAY Fig. 1. Transaxial PET/CT images of the primary breast tumour. Fig. 2. Axillary lymphadenopathy, with abnormal metabolic activity. Fig. 3. Small, metabolically active mass postero-lateral to the uterus. Staging of.indd 75 10/15/08 11:38:03 AM PICTORIAL ESSAY 76 SA JOURNAL OF RADIOLOGY • October 2008 micrometastases in the contralateral ovary. It is known that PET may miss micrometastases.4 The patient was upstaged to M1 with a subsequent change in management. Following chemotherapy, a toilet mastectomy and axillary clearance were performed. Histology confirmed an infiltrating ductal carcinoma with metastatic carcinoma in 5 of the 10 axillary lymph nodes. Post-surgical radiotherapy was not indicated in view of the M1 status. The patient is currently on hormonal therapy and in remission 12 months later. These findings illustrate the utility of F-18 FDG PET/CT in the staging of breast carcinoma, by clarifying an equivocal liver lesion and demonstrating an occult ovarian metastasis. However, this report also shows that the sensitivity of PET/CT regarding micrometastases is limited. 1. Buscombe JR, Holloway B, Roche N, et al. Position of nuclear medicine imaging modalities in the diagnostic work-up of breast cancer. Q J Nucl Med Mol Imaging 2004; 48: 109-118. 2. Eubank WB, Mankoff DA. Current and future uses of positron emission tomography in breast cancer imaging. Semin Nucl Med 2004; 34: 224-240. 3. Lind P, Igerc I, Beyer T, et al. Advantages and limitations of FDG PET in the follow-up of breast cancer. Eur J Nucl Med Mol Imaging 2004; 31: S125-134. 4. Chung A, Liou D, Karlan S, et al. Pre-operative FDG PET for axillary metastases in patients with breast cancer. Arch Surg 2006; 141: 783-789. ayanda mbanga communications (cape) 15778 U N I V E R S I T E I T S T E L L E N B O S C H U N I V E R S I T Y j o u k e n n i s v e n n o o t y o u r k n o w l e d g e p a r t n e r Medical Imaging & Clinical Oncology Radiodiagnosis Professor (Ref. 09TGB324) Duties: Teaching and guiding undergraduate and postgraduate students Requirements: of research. Recommendation: A doctorate. Commencement of duties: 1 December 2008 or as soon as possible thereafter Closing date: 31 October 2008 Enquiries: Appointment is made on the joint personnel of Stellenbosch University and the Provincial Government of the Western Cape. The University will consider all applications in terms of its Employment Equity Plan, which acknowledges the need to diversify the demographic composition of the staff corps, especially with regard to the appointment of suitable candidates from the designated groups. The University reserves the right not to make an appointment. 021 938 9128. Obtain the prescribed application form on our homepage at http://www.sun.ac.za/applicationforms ldavids@sun.ac.za or contacting 021 808 2369. ldavids@sun.ac.za or to The Manager: Personnel Provisioning & Planning, Stellenbosch University, Private Bag X1, Matieland 7602 or fax 021 808 2484. Applicants should request their referees to forward confidential reports by the closing date direct to the same address. Staging of.indd 76 10/15/08 11:38:03 AM