James: mom's PET results, tumor still there

This PET/CT was performed yesterday. Here are the results:

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TECHNIQUE: Approximately 50 minutes after the intravenous administration of 17.1 mCi of FDG, whole body PET/CT imaging was performed. At the time of injection of FDG, the patient’s blood glucose measured 99 mg/dl. Prior to PET imaging, a diagnostic quality CT of the chest, abdomen, and pelvis was performed without contrast.

No prior cross sectional imaging or their reports are available for comparison.

FINDINGS: There is a hypermetabolic soft tissue mass with in the right breast. It measures 5.8 cm x 2.0 cm with a maximum standard uptake value of 7.4. There is diffuse skin thickening within the right breast which has a nodular appearance. It measures up to 6 mm with a maximum standard uptake value of 3.6. The skin thickening extends and overlies the sternum.

There are right axillary lymph nodes measuring up to 12 mm x 8 mm in size with a maximum standard uptake value of 1.4. There is increased glucose metabolism in the right glenohumeral joint which is thought to be degenerative-arthritic.

There is a focus of hypermetabolism associated with the right 11th rib with a maximum standard uptake value of 4.6. It corresponds to a lytic lesion on CT scan with a minor soft tissue component. There is a second lytic lesion involving the lateral left ninth rib with a maximum standard uptake value of 2.3. There is a punctuate lytic lesion with in the sternum which demonstrates low level glucose metabolism on PET scan with a maximum standard uptake value of 1.7. There is an additional lytic lesion at the base of the dens involving the C2 vertebral body with a maximum standard uptake value of 7.6. There is an additional lytic lesion involving the C5 vertebral body.

There is a small-to-moderate right pleural effusion with a maximum standard uptake value of
1.6. There is a moderate pericardial effusion with a maximum standard uptake value of 0.9. Examination of the lung fields is limited by respiratory motion. There is a groundglass opacity in the left lower lobe which demonstrates low level glucose metabolism with a maximum standard uptake value of 1.0. There is a right middle lobe pulmonary nodule measuring 5 mm in size on image 63 of the lung windows. There are small subpleural nodules in the right lower lobe measuring up to 4 mm in size. These findings are not significantly glucose avid but they are below the resolution of PET scan.

There is no abnormal glucose metabolism within the soft tissues of the neck, abdomen, or pelvis to suggest more distal spread of tumor.

The CT examination demonstrates the additional findings: Examination of the brain is unremarkable for mass effect or midline shift. The ventricles are not dilated. There are nonenlarged lymph nodes in the neck, mediastinal, hilar, and left axillary regions. The liver, gallbladder, spleen, adrenal glands, and pancreas have an unremarkable noncontrast CT appearance. There is no hydronephrosis of the kidneys. There is no abdominal or pelvic lymphadenopathy. Findings are suggestive of a fibroid uterus. The bowel loops are normal in caliber.

IMPRESSION:
1. Malignant mass within the right breast. There is probable involvement of the overlying skin which extends and overlies the sternum.

2. Nonenlarged right axillary lymph nodes which demonstrate low level glucose metabolism on PET scan. These findings are more nonspecific and may be reactive in etiology. Metastatic disease cannot be excluded.

3. Findings compatible with bony metastases

4. Right pleural effusion and pericardial effusion which demonstrate low level glucose metabolism on PET scan. These findings are nonspecific and metastatic effusion cannot be excluded.

5. Small nodular opacities in the right lung which are not significantly glucose avid. However, they are below the resolution of PET scan. Attention to these findings on future examinations is advised.

6. Groundglass opacity in the left lower lobe which is mildly hypermetabolic. It favors an inflammatory or infectious etiology. This too can be followed on future chest CT examinations.

7. Probable fibroid uterus. If further evaluation is warranted, correlation with pelvic sonography can be obtained.

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Here is my brother's post from several months ago that includes the PET scan from May and the CT scan from August:

//www.curezone.org/forums/fm.asp?i=1845717#i


This is the paragraph regarding the actual tumor from it:

MAY 2011
"The obtained images show a large tabulated focus of markedly increased uptake in the right breast with standardized uptake values (SUV) 14.8 corresponding to an spiculated 5.2 X 2.3 X 5.3 cm mass in the right breast with two adjacent superficial focus of increased uptake in the right breast with SUV 12.3 at the right nipple and SUV 7.5 at an adjacent medial focus in the right areola corresponding to a diffuse cutaneous thickening (1.2 cm) of the right breast."

NOVEMBER/DECEMBER 2011
"There is a hypermetabolic soft tissue mass with in the right breast. It measures 5.8 cm x 2.0 cm with a maximum standard uptake value of 7.4. There is diffuse skin thickening within the right breast which has a nodular appearance. It measures up to 6 mm with a maximum standard uptake value of 3.6. The skin thickening extends and overlies the sternum."

The mass got bigger in one direction, but got smaller in the other. For whatever reason, the latest PET does not include a height measurement for the tumor, so I cannot calculate its volume. If I disregard the heights, the area of the tumor in the latest scan is slightly smaller: 11.96 cm vs. 11.6. The SUV readings are exactly half in the latest scan: 14.8 vs 7.4. If it matters, the scans were done in different locations, and the oncologist told us earlier that it can cause differences in readings (we did not see her yet, though). The lung nodules decreased to May levels, as the August CT showed 6-9 mm nodules, but the latest PET/CT shows 2 that are 4 and 5 mm, without any additional nodules (May PET/CT showed more nodules as well).

I have a few questions regarding this scan:

1. Why do you think that a height measurement was not included in this scan?

2. How reliable of an indicator are the SUV readings?

3. Why are the right axillary lymph nodes called "nonenlarged" in the impression? It was 14mm in the first scan and called "enlarged," and 12mm in the latest and called "nonenlarged."

4. What do you make of the lytic lesions mentioned in the report? They suggest "Findings compatible with bony metastases," but at the same time, that "There is increased glucose metabolism in the right glenohumeral joint which is thought to be degenerative-arthritic." Are lytic lesions also caused by arthritis? Her calcium levels are normal, I believe, from a blood test taken about a month ago, but that was a whole month ago. Are elevated calcium levels always present for cancer that spreads to the bones? Also, the first PET said that "bones are normal," while this last one shows deterioration in multiple spots. And her bones do hurt, as you already know.

5. Due to the hypermetabolism in the rib area, elevated SUV levels, and the soft-tissue component found there, do you think that the cancer is spreading there? If not, what do all of these components mean?

6. Can the pleural effusion account for some of her pain? What does it mean? Can it be the pus that is now trapped because her wounds are healed? Does this relate to the pleural effusion in the left part of her chest?

7. What is the highest dosage of ozone a person can tolerate 3x day? My mom has been doing 35 u/g, but my brother has said that he read about people doing 47-50 u/g.

8. What do you recommend at this point? Should she go ahead with ozone injections in the chest?

Please let us know anything else that we may have missed and that you have read from this PET/CT. What is your general impression based on the report? We should get the disc mailed out to us soon and my brother will provide you with the images, if necessary.