55-year-old woman with invasive ductal breast cancer. FDG PET/CT was ordered for systemic staging. (A) Axial FDG PET, (B) axial non-contrast CT, and (C) axial FDG PET/CT demonstrate the FDG-avid locally advanced left breast cancer (long arrows). The CT on lung windows demonstrated multiple small rounded nodules, without corresponding FDG avidity on PET. The nodules were called probably benign on the original report, noting lack of FDG avidity. Second opinion report called the lung nodules probably malignant. Biopsy demonstrated metastatic breast cancer, which increased the patient’s tumor stage to IV.