Case Study

1. Getting to the heart of the matter!
Todd Charge
Senior Technologist
Nuclear Medicine and PET Centre
Hunter Health Imaging Service
Hunter Health Imaging Service

2. Background
• 29yr old female
• Benign cyst removed from Right breast
1995
• Fatty lump noted at time
• Regular follow up U/S
Hunter Health Imaging Service

3. Background
 U/S Dec 2002 abnormal right breast
 Mammogram widespread calcification
 Palpable axillary nodes
 U/S adbo, chest clear
 CXR normal
 FBC, biochem normal
 LFT, serum alkaline phosphatase normal
Hunter Health Imaging Service

4. Background
 CXR Jan 2003 abnormality R lung base
 CT normal
 5 days later
 Right side mastectomy
 Axillary dissection Post op evacuation of
haematoma
Hunter Health Imaging Service

5. Background
 Invasive ductal carcinoma
 Measuring 10cm
 Grade 3
 Pagets disease invol nipple
 Extensive lymphatic, vascular invasion
 18/27 lymph nodes involved
 Extension up to 2mm beyond capsule
Hunter Health Imaging Service

6. Background
 Oestrogen, progesterone receptors neg.
 Her-2 marker strongly positive
 High risk of local recurrence
 Required radiation treatment and chemo
 10yr survival 13%
 With chemotherapy inc. to 30%
Hunter Health Imaging Service

7. Background
 Smoker (ceased six years)
 Social drinker
 Three children, unremarkable pregnancies
 No family history breast cancer
 24 weeks pregnant
Hunter Health Imaging Service

8. Treatment
 Six cycles of AC chemotherapy
 Three weekly
 Plan to deliver at 37 weeks
 Post delivery commence radiation treatment
 Monthly foetal growth U/S
 No randomised studies
 Case studies suggest no detrimental effects
Hunter Health Imaging Service

9. Treatment
 Induced labour, normal vaginal delivery
 Normal, healthy 8.3pound female infant
 Breast feeding successfully on left breast
 Paused breastfeeding for 5 days to
complete sixth cycle of chemo
 Right chest wall irradiation with inclusion of
lymph node drainage areas
Hunter Health Imaging Service

10. Treatment
 No evidence of local recurrence or distant
disease
 Commence Herceptin trial
 Baseline LVEF
Hunter Health Imaging Service

11. Administration
• 1ml Radpharm PYP IVI via left posterior
hand
• 1hr interval
• 900MBq Tc04- IVI via left cubital fossa
• Imaging commenced immediately
• 3 lead ECG gating
Hunter Health Imaging Service

12. Scanning
• Anterior, LAO35, Left Lateral views
• 10 mins per view
• 24 bin gating
• 75-85bpm heart rate
• Normal sinus rhythm
Hunter Health Imaging Service

13. Images
PScope
Hunter Health Imaging Service

14. Images
LAO35 Static
Hunter Health Imaging Service

15. Images
Anterior Cine
Hunter Health Imaging Service

16. Images
LAO35 Cine
Hunter Health Imaging Service

17. Images
LtLat Cine
Hunter Health Imaging Service

18. Images
Gated SPECT
Hunter Health Imaging Service

19. Images
Zoomed Short Axis
Hunter Health Imaging Service

20. Outcome
 Normal wall motion
 No LVEF due to technical difficulties
 No evidence in literature search
 Highlights the need to consider uptake of
radiopharmaceuticals in lactating females
as normal variant
 Gated SPECT processed same as
Sestamibi/Thallium cardiac to obtain LVEF
after overcoming technical difficulties
Hunter Health Imaging Service