Figure 2.

Fluorodeoxyglucose positron emission tomography/computed tomography (¹⁸FDG-PET-CT) findings at initial staging in a 45-year-old woman with a 60-mm invasive ductal carcinoma of the left breast (tumor phenotype = estrogen receptor positive, human epidermal growth factor receptor 2 negative, grade 2). The patient had no regional lymph nodes metastases at clinical and ultrasound examination (cT3 cN0 cM0; stage IIB). A) Maximum intensity projection PET image showing ¹⁸FDG uptake in the primary tumor (white arrow), and also FDG uptake foci in the liver (black arrows). B, C) Sagittal and coronal projections PET-CT fusion images through the left breast showing the primary tumor (white arrows). D) Axial projection PET-CT fusion image through the liver dome showing a ¹⁸FDG-avid liver lesion (white arrow). E) Coronal projection image showing the same metastasis (white arrow). No metastases had been depicted on initial liver ultrasound but abdominal contrast-enhanced CT performed after PET-CT confirmed liver metastases. The patient was upstaged to cT3 cN0 cM1 (stage IV). Chemotherapy regimen was adapted to metastatic disease. Following primary chemotherapy, mastectomy and axillary clearance showed a residual breast primary with pathological response >50% and no metastases in the 14 removed nodes. Then, right liver surgery was performed and showed residual metastases. Radiation therapy to the chest wall only (without regional nodal basins irradiation) was performed, and the patient received adjuvant hormone therapy. In the 7 months since liver surgery, no recurrence was documented.