15.11.2017

QUESTION: Vitaly Aleksandrovich, according to the results of a CT scan with contrast (2 months have passed since the mastectomy) in the left axillary region - postoperative hardening of soft tissues in an area of ​​​​about 25x19x32 mm, with perifocally dense subcutaneous tissue. What does this mean?

ANSWER: Hello! This means that most likely you have a lymphocyst there and it needs to be punctured, or simply fibrosis. You did this research early, the tissues have not yet had time to heal and recover! It would be better if you show this soft tissue thickening to your oncologist.

02.12.2017

QUESTION: Vitaly Alexandrovich! CT scan with contrast, the diagnosis is questionable aseptic necrosis right shoulder joint. Cysts of the head of the right shoulder joint 8 mm and 3 mm. Do you think that if the contrast has not accumulated, you can be 100% sure that it is not MTS?

ANSWER: I think it’s not MTS after all! In the metastatic process, other signs of bone damage!

01.02.2018

QUESTION: Vitaly Aleksandrovich, according to the conclusion of computed multislice tomography with a contrast agent of 800 ml of 3% trazograf solution orally and 40 ml of ultravist intravenously, single focal compactions in the lungs are of the fibrous series? (CT control), small single foci of sclerosis in the bones of the studied level. Based on this conclusion, from your point of view, is there cause for concern? Thanks a lot.

ANSWER: Hello! Given a history of breast cancer, you should always be observed and look at these lesions, you just need to do it regularly!

05.02.2018

QUESTION: Vitaly Alexandrovich, please help. Mammography 8 months ago revealed a lump of about 3 cm in the left breast, upper outer quadrant. That's almost all the description. Repeated M-graphy after 6 months is recommended. Eat aching pain in the breast, sometimes they depend on the cycle, sometimes not. The left shoulder blade and left hypochondrium also hurt. There was an injury to the left hypochondrium 25 years ago. But she didn't bother me. An X-ray of the ribs shows only the old crack of the ribs. I have intervertebral lumbar hernia. The neurologist explains that the degenerative process could also affect thoracic region spine. Hence the pain in the scapula, which radiates to the breast, but I recommended checking the breast. Intercostal neuralgia was excluded by the neurologist. The left breast is slightly larger than the right. But it was like that before. I did an ultrasound three times and the descriptions were completely different. But according to the doctors, there is nothing criminal. The mammogram was extremely painful, there was a lot of pressure on the breast, so I did an MRI without contrast. Without contrast, nephrologist's recommendation. There are no MRI descriptions without contrast, but there are pictures and a disk. At the clinic where I had an MRI, they said that there was no point in doing an MRI without contrast. This is true? Did I do an MRI without contrast in vain? Or can pictures help clarify the picture? Your recommendations to mine further actions? Still a repeat mammogram? Puncture?
Thank you in advance!
Best regards, Evgenia.

ANSWER: Hello! Does your institution where you do mammography (mammography test) - this is mammography with simultaneous biopsy under X-ray control - it definitely doesn’t miss! This is the first thing you can do! The second is an MRI with contrast, but the essence is the same, namely - no biopsy! Therefore, perhaps there is no point in MRI! !Or the simplest method is ultrasound-guided biopsy! It seems to me that you have nothing there, with such pain as yours, there would have been metastases in other places long ago, there were visible manifestations on the gland, so do as I said - an ultrasound-guided biopsy or a mammography test! Have you contacted your oncologist, he should know all this! Where do you live?

07.03.2018

QUESTION: Vitaly Aleksandrovich, I already asked you a question, you turned out to be right, they confused me in the epicrisis, instead of non-adjuvant therapy they wrote adjuvant therapy. I would like to repeat my question: after non-adjuvant therapy and organ-saving surgery, my epicrisis says - therapeutic pathomorphosis of the 1st degree. Is it possible to make a prognosis based only on pathomorphosis? Thank you.

ANSWER: Hello! Why did you undergo organ-saving surgery with such an advanced process? Neoadjuvant chemotherapy is used for advanced or edematous breast cancer. Organ-conserving surgery is usually not performed after neoadjuvtive chemotherapy! It seems to me that the prognosis will not be very favorable, since the standardization of treatment has been violated! To improve this indicator, you need to undergo radiation therapy and resolve the issue with adjuvant chemotherapy!

18.03.2018

QUESTION: Vitaly Alexandrovich, is it possible to do a CT scan with contrast immediately after radiation therapy? Or is it better to take a break? Thank you.

ANSWER: Hello! Of course, you can do it, but there is no point, it is better to do it after 6 months, but do not be alarmed if in conclusion there are changes in the lungs like frosted glass! These are typical changes in the lungs after radiation therapy - post-radiation fibrosis!

08.04.2018

QUESTION: Vitaly Aleksandrovich, in the description of multislice computed tomography with contrast agent 800 ml of 3% trazograf solution orally + 40 ml of ultravist intravenously: focal compactions were noted in the lungs: on the right in S8 - 3x2 mm and on the left in S4 in the raincoat sections - 2mm d . Also on the right in S1 is a pleuropulmonary commissure. Could these isolated focal densities be fibrous? be a consequence of radiation therapy. Thank you.

ANSWER: Hello, based on these signs, most likely you have focal fibrous compactions, which could well be a consequence of radiation therapy, in in this case Usually they do a follow-up CT scan after 3-4 months!

08.04.2018

QUESTION: Vitaly Alexandrovich, good evening! After mastectomy, before chemotherapy, I had a CT scan with contrast. In conclusion, small isolated foci of sclerosis in the bones of the studied level are written. At the level of the study, small foci of sclerosis were noted in the head of the right humerus - 1 mm, in the anterior parts of the body of the Th5 vertebra - 1 mm, in the right parts of the body of the L2 vertebra - 3x2 mm and in the roof of the right acetabulum - 1.5 mm d. Do I have a reason to worry? Thank you.

ANSWER: Hello! There is always a reason for concern, since there is a history of breast cancer, in this case you just need to do CT controls this study!

08.04.2018

QUESTION: Vitaly Aleksandrovich, with a CT scan of the chest organs, the left mammary gland has been removed, in the left axillary region there is a postoperative thickening of soft tissues in an area of ​​​​about 26x18x31 mm, with perifocally dense subcutaneous tissue. In the right mammary gland additional education not detected, right axillary lymph nodes without pathological enlargement up to 10 mm d and max 14 mm d. with fatty involution. 2 months have passed since the mastectomy. Is this CT description a variant of the norm? Thank you.

ANSWER: Hello, in your case this is the norm for you!

23.07.2018

QUESTION: Hello, Vitaly Alexandrovich! Please consult. Breast cancer, triple negative cancer. surgery in March 2017, the last chemotherapy was in September 2017. On a routine CT scan in July 2018, they write - lymphadenopathy of the retroperitoneal lymph node of a nonspecific nature and lymphadenopathy of the mediastinal nodes, the size of the lymph nodes is 5-6 mm. The doctor said this is normal. I would really like to hear your opinion on this matter - is there really nothing wrong with this or does it still indicate an ongoing oncological process?

ANSWER: Hello! Indeed, your doctor is right: these are normal lymph nodes and now it is impossible to say that they are malignant! This is the norm! You just need to repeat the CT scan in 3-4 months and if everything is the same, then do this study once a year!

12.11.2018

QUESTION: Hello, Vitaly Alexandrovich! TN breast cancer, organ-preserving surgery, 8 courses of chemotherapy and radiation, treatment completed in September 2017. I contacted you with questions. Thank you very much for your answers. A CT scan from the moment of diagnosis showed lymphadenopathy of the retroperitoneal lymph node and mediastinum. On the last CT scan it was written that these lymph nodes began to accumulate contrast. No colds or infectious diseases I didn't have any CT scans for three months. Please tell me what this could mean?

ANSWER: Hello! This can mean anything, the accumulation of contrast occurs not only in a malignant process, in your case it is necessary to exclude the progression of the tumor, the specialist describing the CT scan of this department should specifically say what it is! We need to ask him this question. Also, to exclude this tumor progression, mediastinoscopy is sometimes performed. What your oncologist tells you, he knows you better. My advice: in this case, it is necessary to exclude progression and therefore you need to contact an oncologist at your place of residence.

13.11.2018

QUESTION: Vitaly Alexandrovich, thank you for your answer to the question about the accumulation of contrast in the lymph nodes. That's why I turned to you, because my doctor says that this is the norm and let me go until March. But what still worries me is that they didn’t accumulate contrast before. Maybe we should do a PET scan?

ANSWER: Hello! You can do a PET scan if you have such an opportunity, but if your doctor is sure that there is no growth of nodes over time, then this really happens, I wrote to you about this in the first answer, that accumulation does not only happen with malignant formations! If there is no dynamics, then it means we really need to postpone the study to March!

20.11.2018

QUESTION: Good afternoon, Vitaly Alexandrovich. I was treated for breast cancer with a mastectomy in February 2018, chemotherapy and radiation. I did a CT scan of the lungs. Conclusion: a single lesion in S1 of the right lung. Post-radiation changes in S4-S5 right lung. In area surgical intervention accumulation of liquid 5.8x8.4x1.3, density +10HU. Could you please explain the result. Thank you in advance.

ANSWER: Hello, on your CT scan they wrote that you have post-radiation changes in the area where the gland was irradiated, they also wrote that there is a suspicion of cancer metastasis to the lungs in the S 1 segment, but this needs to be looked at over time in 2-3 months, the treatment should not be changed now and it seems to me that this is most likely not cancer metastasis, but also some changes that were previously or associated with radiation therapy!

12.12.2018

QUESTION: Is it safe to do a CT scan after surgery when the stitches have not yet been removed?

ANSWER: Hello! Of course, this procedure is safe, and you can perform it if you were prescribed this test and now after the operation it makes sense.

03.01.2019

QUESTION: Vitaly Alexandrovich, thank you very much for your quick response! Tell me, please, when after the end of treatment can and should CT and osteoscintigraphy be done? And what three zones should be examined on CT? And also regarding tamoxifen, should you basically take it 2 times a day or can you take 20 mg once a day? Is varicose veins a contraindication? Maybe I should drink something for prevention? Thank you!

ANSWER: Hello! CT scan of three zones - rib cage, abdomen and pelvis, a year after the last CT scan, if you haven’t had a CT scan, then you can do it now, or better yet, 6 months after radiation therapy and then do it a year later, do it once a year, you can do it even today! It is better to take Tamoxifen 20 mg once a day than 10 mg twice a day! Varicose veins are not a contraindication, take it calmly! To prevent thrombosis, it is better to seek advice from a vascular surgeon; in Russia they take, for example, thromboass or cardiomagnyl!

02.02.2019

QUESTION: Good afternoon I have been worried about problems with my lungs for at least 15 years. No one has determined anything, Personally, I assume chronic inflammation or tuberculosis. There is practically no cough or sputum. Pain in the back position and breathing problems are relieved with antibiotics. There is constant purulent content in the nose, flowing into Airways- no treatment - 30 operations (osteomyelitis?). According to PET, the lesions in September 2018 were inactive, multiple, after 1.5 months. according to CT - the same foci (fibrosis) are already MTS. I am undergoing chemotherapy and at the same time taking antibiotics on my own. I think prednisolone and dexamethasone make things worse when your white blood cells are low. Antibiotics reduce ESR. The pus in the nose becomes more active. Laura is tired and shy away. I don't believe in MTS. What is your opinion? Thank you.

ANSWER: Hello! You didn’t even indicate what cancer metastases you have!!! Phthisiatricians have ruled out tuberculosis? During chemotherapy, everything always gets worse accompanying illnesses. My opinion on what exactly do you need?

10.09.2019

QUESTION: MSCT showed moderate febrile induration, is this cancer?

ANSWER: Hello! In any examination there is a description of this examination method and at the end a conclusion, which states what is being discussed and the diagnosis. What you are asking me is most likely not cancer, contact a specialist with this conclusion, and he will comment on it for you.

27.09.2019

QUESTION: Hello, a month and a half ago I caught a cold - I had a runny nose, cough and the temperature lasted for 3 days! everything went away; all that was left was a cough with copious sputum, similar to snot! doesn't work! I did X-ray - lungs clean, then the therapist sent me to a Pulmonologist. They did an FVD - the test was negative, and a CT scan of the lungs! The CT scan shows the following picture: - C4.5 fibroatelectasis of the right lung with traction bronchoetasis. Deformation of the lumen of the bronchi PB4, PB5 and SDB. The walls of the segmental and subsegmental bronchi in C3 on the right are emphasized in a muff-like manner. - in other segments without foci and infiltration - VGLUs are not enlarged - fluid in the pleural cavities is not detected - the trachea and large bronchi are passable - the heart is not dilated, the ascending aorta is 38 mm. Calcium salts along the left anterior variable coronary artery - soft fabrics not changed - DDZP was sent for repeat to a pulmonologist, recording in 10 days only. Can you briefly decipher it, otherwise I’m very worried! Nothing bothers me except the cough. Thank you! They recommend bronchoscopy, but they say that they cannot see the tumor! They just don't say it?!

ANSWER: Hello! I am not an expert in this area, consult a thoracic surgeon.

24.10.2019

QUESTION: Hello! How long after scintigraphy can PET-CT be performed? Thank you.

ANSWER: Hello! Isotopes after osteoscintigraphy are removed within 24 hours, I think that this study can be performed after maintaining this interval, the specialist who performs the PET study can accurately answer your question.

25.10.2019

QUESTION: Hello! Diagnosis of breast cancer T2N1M0 ER40% 4 points, PgR 40% 4 points. HER2/neu0, Ki67 more than 20%. They prescribed 8 chemo treatments, after the 6th they did osteoscintigraphy - scintigraphic signs of a single focus of hyperfixation of radiopharmaceuticals in the manubrium of the sternum and small foci of increased accumulation of radiopharmaceuticals in the projection of the 1st rib on the left. To confirm, they sent me for a CT scan, the conclusion was: signs of a formation in the left mammary gland; mts of the sternum cannot be excluded. What does this mean, what is the forecast? And has the diagnosis been established accurately, regarding metastases, or is some other examination needed to clarify? Thank you.

ANSWER: Hello! In this case, there is a suspicion of metastases in the bones, for this you need to look at the dynamics again in a few months with a CT scan, now continue treatment according to this regimen, the prognosis is based on the full picture of this disease, that is, confirmation of metastases in the bones. This examination has been completed and is sufficient.

26.10.2019

QUESTION: Good afternoon To accurately determine the presence of metastases in the spine and describe their size and further monitor the dynamics of treatment, which is better to do an MRI or CT scan of the spine?

ANSWER: Hello! It is best in this case to perform computed tomography, ideally PET, but CT is sufficient because it is the most accessible and exact method to assess the dynamics of metastatic lesions.

02.11.2019

QUESTION: Hello, 2 weeks ago I had oncoplastic resection of the left breast and axillary lymphadenectomy. Tumor less than 2 cm, according to histology: infiltrative streaming cancer of 2nd degree of malignancy with invasion of lymph vessels; tumor growth in seven lymph nodes. There is no IHC conclusion yet. Please tell me whether there is any point in carrying out additional examinations(CT, MRI); Before the operation I only did an ultrasound (of the mammary glands, abdominal cavity and pelvis) and x-ray of the lungs.

ANSWER: Hello! As a result, the stage is high and there is, of course, a point in performing a computed tomography to exclude a metastatic process to other organs.

05.11.2019

QUESTION: Is it possible to find out whether pulmonary fibrosis and metastases are the same wording or various diseases?

ANSWER: Hello! Of course it is different processes, and they have different clinical picture when described on tomograms.

05.11.2019

QUESTION: Good evening! She underwent fluorography as planned, which showed that the left root was enlarged and polycyclic. Then a CT scan of the lungs was performed: airiness lung tissue not changed, focal and infiltrative changes were not identified. The lobar, segmental and subsegmental bronchi are not deformed and have a normal lumen. pleural cavities are free, the pleural layers are not changed, the lymphatic nodes of the left root are enlarged to 13 mm. There are no formations in the mediastinum. Heart unchanged. Bone - destructive changes not found. Conclusion: Lymphadenopathy of bronchopulmonary lymph nodes on the left. What does this mean?

ANSWER: Hello! This conclusion The radiologist who described this image should interpret it, it seems to me that in this case there is nothing serious, and an enlarged lymph node may be normal.

Breast diseases in women are a common problem. If you consult a doctor on time, most pathologies can be diagnosed and completely cured. One of the auxiliary research methods is computed tomography.

Breast CT scan is an examination of organ tissue using X-rays. The device used for diagnostics creates a beam of rays. The way they pass through the soft tissue allows us to determine the presence of neoplasms. Rays pass quickly through normal, homogeneous tissue.

When dense clusters of cells are encountered in the path of X-rays, their movement slows down. This shows the presence of neoplasms. This computed tomography clearly visualizes all the compactions, later reflecting them on the resulting image. The sensor moves along with the beams in the device, collects information, and transmits it to the computer. As a result, it is possible to create a three-dimensional model of the breast.

CT mammary glands doesn't count mandatory method diagnostics Every woman should regularly visit a mammologist to monitor her health.

However, CT is prescribed when, after palpation and ultrasound of the breast, there are still suspicions of the presence of unidentified neoplasms. The tomogram obtained as a result of a CT scan, in contrast to a conventional x-ray, makes it possible to evaluate a specific area, tumor, location in the tissue.

PET diagnostics appeared quite recently and is considered one of the rapidly developing methods for studying the mammary glands. Mammologists around the world recognize it as the most sensitive, and therefore highly effective way to determine the degree of development of breast cancer.

PET involves the introduction of a radiochemical drug. For this purpose, substances are used that will be actively absorbed by a malignant tumor, if any. After administration of the radiochemical drug, standard procedure tomography.

If a cancerous tumor is detected, it becomes colored bright color. The resulting image can not only determine the size of the tumor, but also reveal the processes that occur inside it.

The disadvantage of PET CT is the strong radiation, so such a study is rarely prescribed for cancer patients and is carried out strictly under the supervision of a doctor.

Advantages and disadvantages

Ultrasound, MRI, and some other types of diagnostics are prescribed more often than CT. However, sometimes this research method cannot be avoided. The advantages of computed tomography of the mammary glands are:

• Accurate recognition of compactions located in the deepest layers of gland tissue.
• Detailed visualization of how much the tumor has spread to other tissues.
• The ability to determine the nature of the tumor - benign or malignant.
• High information content.

The advantage of CT is that it can be performed with breast implants. IN modern clinics the following are used silicone implants, which are transparent to X-rays.

The disadvantages of the study include the high degree of radiation exposure and the cost of diagnostics. Also when large sizes breast, computed tomography may not provide accurate information. This is explained by the design features of the devices. In any case, the method of diagnosing the mammary glands is always determined by the attending physician.

Indications and contraindications for CT

CT scan carried out as an addition necessary to clarify the diagnosis or the impossibility of studying all the details using other methods. Most often, it is prescribed when the presence of a tumor in the breast is established, but ultrasound, MRI, and palpation do not provide grounds for determining its nature or connection with other organs and tissues.

The main indications for CT scanning are:

• Determining the location of the tumor.
• Detection of metastases, determining how much other connective tissues are affected.
• Examination of lymph nodes located close to the tumor, determination of inflammatory processes and complications in them.
• Determining how resectable a tumor is.

Given the high degree of exposure to x-rays, CT has a number of contraindications. First of all, you can’t do it more than twice a year. Contraindications also include:

• Pregnancy
• Childhood (there is no exact figure, the doctor assesses the need for research, the child’s ability to lie quietly without moving in the device)
• Epilepsy
• Claustrophobia, other acute mental disorders
• Presence of a pacemaker
• Excess weight - most tomography machines are designed for weights up to 120 kg

Mental disorders are considered a relative contraindication. If in this moment the patient can control herself, has undergone therapy, can lie still, the doctor may consider it appropriate to prescribe a procedure.

Risks during the examination

Risks associated with possible harm from x-rays. Sometimes after diagnosis the patient may feel weakness, slight nausea, loss of strength, or faintness. However, all these signs of the effects of rays on the body disappear on their own within a few hours.

Despite the possible risks, doctors' reviews of computed tomography of the mammary glands are mostly positive.

If a woman is weakened, inflammatory processes occur in the body, chronic diseases have worsened, diagnosis is simply postponed until the condition improves.

How is computed tomography of the mammary glands performed?

Breast CT is performed on certain days menstrual cycle– from 5 to 10. During this period, no hormonal changes interfere with obtaining a clear image of tissue. On other days, the study can also be carried out, especially if there is an urgent need for it. However, swelling and other changes may affect the reliability of the result.

The patient lies down on the table of the device, which slides inward. She lies on her back, calmly, with her arms at her sides. It is important to take a comfortable position so as not to move for several minutes. The radiologist, after the patient has moved inside the ring of the device, talks to her through the built-in loudspeaker and can give additional instructions.

The duration of the entire procedure usually does not exceed 30-40 minutes. However, the patient spends several minutes in the device itself. The rest of the time is needed for preparation and training.

Use of contrast agent

In most cases, a CT scan requires contrast - the injection of a dye into a vein. It is usually injected together with saline, which allows it to quickly penetrate the soft tissue. A feature of conducting contrast is the possibility allergic reaction on him. Therefore, before the study, the doctor needs to make sure that the patient has normal tolerance to this substance.

The list of contraindications for tomography with contrast is increasing. It adds:

• Allergy to iodine
• Renal dysfunction
• Severe diabetes mellitus
• Exacerbation of thyroid diseases

Results and doctor's opinions

The radiologist's report is given to the patient along with the completed image. The specialist carefully examines the image obtained on the screen, assesses the condition of the affected tissue, nearby tissues and organs.

Usually the conclusion is issued immediately, sometimes you may have to wait several hours. This occurs in situations where the radiologist needs advice from other specialists. With the received diagnostic results, the woman goes to her attending physician to receive a therapy prescription.

Thus, computed tomography of the mammary glands is a common diagnostic method that allows you to confirm or refute the presence of a tumor, determine its nature, and other details that are not noticeable with other research methods. Taking into account contraindications and possible harm X-rays, CT is prescribed strictly by the attending physician no more than twice a year.

Breast cancer is the most common malignant tumor in women around the world and in Russia. In the last decade, more than 50 thousand new cases of this type of cancer are registered annually in our country. In 2010, breast cancer ranked first both in terms of the incidence of malignant neoplasms in Russian women (20.5%) and in their mortality from malignant neoplasms (17.2%). Breast cancer is much less common in men than in women.

PET/CT diagnostics for breast cancer

For early detection and effective treatment of breast cancer great importance has high-quality screening. When early detection disease chances for it successful treatment significantly higher. Current methods for diagnosing breast cancer are based on mammography, ultrasound and biopsy identified neoplasm. PET/CT examination can show whether a breast mass is benign or malignant and can also provide useful complements to the data obtained from mammography. PET/CT may also provide additional benefits when evaluating patients with breast implants and women with non-standard breasts. This type of examination is effective in planning a biopsy.

Results of PET/CT examination with 18F-FDG. Focal formation
in the left mammary gland with metabolic activity
radiopharmaceutical.

PET/CT has shown high efficiency in detecting metastasis for breast cancer. This diagnostic method allows for accurate staging of breast and axillary involvement. lymph nodes. Lymphadenectomy (removal) of the axillary lymph nodes is currently a standard element of complex treatment for breast cancer, as this was the only way to adequately stage this disease in the absence of access to PET/CT diagnostics. However, various complications may develop with lymphadenectomy, including reduced arm mobility, swelling and painful sensations. The use of PET/CT makes it possible not to perform lymphadenectomy in patients who do not have lymph node involvement.

You can ask a question about the use of PET/CT diagnostics
for breast tumors, our leading specialists:

Abashin Sergey Yurievich, MD, PhD, professor, oncologist, chemotherapy doctor, Moscow

Rucheeva Natalia Alexandrovna, Ph.D., Head. Department of Radionuclide Diagnostics, radiologist-radiologist, Moscow

Ivannikov Vitaly Valerievich, head of the “Radiation diagnostics” department, radiologist-radiologist, Moscow

The role of PET/CT in treatment

Treatment of breast cancer, like therapy of other types oncological diseases, significantly depends on the stage of the disease. In some cases, surgery may be recommended to remove malignant neoplasm, as well as subsequent use of radiation therapy, chemotherapy or hormonal therapy.

Carrying out PET/CT examination in the nuclear center
medicine "PET-Technology", Moscow

PET/CT provides oncologists additional information for improved planning of the nature and volume of chemotherapy administered. This diagnostic method also provides doctors with valuable information regarding the optimal localization of radiation therapy. The information provided by PET/CT is used to develop personalized treatment that takes into account individual characteristics tumors of a specific patient.

Throughout the entire treatment program for a patient suffering from breast cancer, it is necessary to know how the body reacts to the therapy and whether it is effective. As a rule, metabolic changes occur earlier than anatomical ones. When PET/CT reveals a significant reduction in tissue uptake of radiopharmaceuticals (diagnostic drugs used to detect cancer), this indicates that the treatment is effective.

The information provided by PET/CT allows physicians to adequate monitoring of the effectiveness of antitumor therapy and provides the possibility of prompt adjustment, if the current antitumor effect does not meet the expectations of the patient and the doctor. Typically, the doctor performs a repeat PET/CT scan after 1-2 cycles of treatment and compares it with the results of the previous PET/CT scan. In any case, both during diagnosis and treatment of breast cancer, the decision on the timing of PET/CT is made by the attending physician.

PET/CT and postoperative follow-up

After completing a comprehensive treatment program for breast cancer, it is important to find out whether there are active cancer cells left in the patient’s body, that is, to carry out restaging. To do this, a PET/CT scan of the whole body is performed to detect the remains of a malignant neoplasm. At effective treatment and complete destruction cancer cells PET/CT does not detect foci of radioactive glucose accumulation.

Often on a CT scan, scar tissue in the area surgery or radiation exposure may appear abnormal. In such cases, a PET/CT study is helpful, allowing one to observe the accumulation of radioactive glucose in suspicious areas. Thanks to this, it becomes possible to differentiate healthy scar tissue from relapses of malignant neoplasms and residual effects diseases. Applications of PET/CT helps eliminate unnecessary biopsies and surgical intervention in cases where mammography does not provide a clear understanding of the situation.

Benefits of PET/CT

PET/CT technology offers numerous benefits to breast cancer patients. PET/CT is a non-invasive type of examination used to stage breast cancer, localize the tumor, develop an optimal radiation therapy program, assess the response of the malignant neoplasm to treatment and detect relapses.

Advantages of PET-Technology nuclear medicine centers

PET-Technology company thanks expert level qualified specialists and the availability of modern equipment can provide the best quality of diagnosis, observation and treatment of patients suffering from breast cancer. The high-tech equipment we use helps ensure maximum diagnostic accuracy for this disease.

The following literature was used in preparing the material:
Conti, Peter S., Aarti Kaushik. PET-CT: A Case-Based Approach // Springer. – 2015.
Kim, E. Edmund, Myung-Chul Lee, Tomio Inoue, Wai-Hoi Wong. Clinical PET and PET/CT: Principles and Applications // Springer Science & Business Media. – 2012.
Peller, Patrick, Rathan Subramaniam, Ali Guermazi. PET-CT and PET-MRI in Oncology: A Practical Guide // Springer Berlin Heidelberg. – 2012.
Shreve, Paul, David W. Townsend. Clinical PET-CT in Radiology: Integrated Imaging in Oncology // Springer. – 2010. –
Waterstram-Rich, Kristen M., David Gilmore. Nuclear Medicine and PET/CT: Technology and Techniques // Elsevier Health Sciences. – 2016.

FAQ :

What does it diagnose?

• Mammary cancer

Equipment :

PET/CT for breast cancer

PET/CT for breast cancer

Breast cancer is a malignant formation of the glandular tissues of the mammary gland. According to various statistical centers, breast cancer cases account for up to 25% of all diagnosed cancers. Every year in our country alone, the disease claims the lives of 25 thousand women. The global figure is even more impressive. Therefore, the modern medical community places emphasis on early diagnosis of breast cancer, which not only prolongs life and improves its quality for cancer patients, but also significantly increases the chances of a full recovery.

PET/CT is the most informative and accurate diagnostic technique available today malignant tumors mammary gland.

Diagnostics before PET/CT.

In general, diagnosis of suspected breast cancer begins with ultrasound examination or mammography followed by consultation with an oncologist. As additional and clarifying studies, puncture biopsy and MRI can be performed. Magnetic resonance imaging is a fairly accurate research method that allows you to localize tumors. The reliability of MRI in diagnosing breast tumors (especially in conjunction with a biopsy) reaches 80%, which is significantly higher than that of mammography, but slightly less compared to PET/CT. However, it has one significant drawback - the tomograph is not able to recognize tumors on early stages, when their diameter does not exceed 5 mm.

Indications and contraindications for PET/CT.

Indications for PET/CT are:

• diagnosis of breast cancer in the early stages;
• choice of treatment method;
• monitoring of the chosen treatment method;
• search for regional metastases;
• breast cancer staging;
• search for the primary tumor;
• assessment of response to therapy (chemo- or radiation) and surgical treatment;
• predicting the possibility of relapse;
• breast cancer recurrence study.

PET/CT is a non-invasive and safe method, but despite this, it is carried out only with the direction of the attending physician. In addition, like any other study, it has its own list of contraindications:

• high level of glucose in the blood (PET/CT can be performed only after consultation with an endocrinologist and reducing the sugar level to acceptable);
• pregnancy (PET/CT is only possible if the importance of obtaining information is higher than the expected risks);
• lactation period (the procedure is also possible, but breastfeeding within 2 days after the examination is not allowed);
• renal failure (difficulties may arise with the removal of the radiopharmaceutical, but the possibility of PET/CT is allowed after renal tests and the conclusion of a nephrologist).

Advantages of PET/CT.

Currently, this is the most accurate method for diagnosing cancer tumors in cancer patients. Compared to other examinations, PET/CT has a number of advantages:

1. high reliability of the data obtained (up to 90% when detecting breast cancer and up to 40% when searching for regional and distant metastases);
2. the ability to see cancerous changes at the molecular level;
3. helps to create individual treatment courses and predict the development of cancer in the coming year;
4. the possibility of objective assessment of the effectiveness of the treatment;
5. except localization structural changes breast tissue, you can also obtain information about the quality of the processes occurring.

Preparing for the study.

As such, preparation for the study is not required. There is only a list of recommendations, following which PET/CT will be performed with the least discomfort, and the results obtained will be more indicative:

• do not drink any alcohol for at least 2 days;
• one day before the appointment, do not drink tonic drinks or smoke, and do not eat food 6 hours before PET/CT;
• It is recommended to get enough sleep and rest before the study;
• find out your weight - this is necessary for accurate calculation radiopharmaceutical (RP) dosage;
• For better hatching radioactive substances removed from the body, drinking plenty of fluids on the eve of the procedure is recommended.

If you have one of the above contraindications, you should inform your doctor about it in advance.

How is it carried out?

Upon arrival at the site for PET/CT of the breast, it is necessary to remove all metal elements from clothing and the body.

Next, a radiopharmaceutical is administered intravenously; in the case of the mammary gland, 18-fluorodeoxyglucose is used. When the drug is evenly distributed throughout the body tissues (about 1 hour is required), the patient is placed on an open table (no closed chambers, which is also a plus compared to MRI). From this moment on, the sensors examine the selected area centimeter by centimeter, transmitting the information received software a device that creates a metabolic map of the body.

Interesting! PET/CT diagnostics are carried out in the “whole body” mode, which is inappropriate when examining a small area - the breast in this case. Pilot studies are currently underway on completely new PET scanners, designed specifically for breast examination and capable of highly efficient detection of lesions up to 5 mm in size.

Upon completion of the procedure, the doctor performs a follow-up examination of the patient, after which you can safely go home. The results of the study are deciphered within 3 days, after which the conclusion is given to the patient or sent to his attending physician.

Cost of the study.

Breast PET/CT examination can be done in both public and private medical centers, both on a paid and free quota basis.

Important! To undergo a free PET/CT scan, you must have a policy health insurance and referrals from the attending physician.

But it is worth understanding that the number of people willing to undergo such an examination for free is disproportionately higher than the capabilities of our medical institutions. Therefore, the waiting list for an appointment can last for months.

A paid PET/CT scan will significantly speed up the process, where the queue for the procedure, as a rule, does not exceed 5 days. But, unfortunately, not all Russians can afford such an expensive service. The price of PET/CT is on average 55,000-90,000 rubles and depends on the location and prestige of the medical center, level of patient service, quality of equipment and complexity of the case.

Breast oncology - website – 2010

CT scan

Computed tomography is a method radiology diagnostics, which consists in the fact that rays pass through one or another area of ​​the body at different angles. After this, the information enters the computer, where it is processed and an image of a tissue section at a certain depth is formed.

Computed tomography is a non-invasive method (does not require surgery), safe and used for many diseases. Your doctor may order a CT scan if you have a large breast tumor to find out whether the tumor is operable or not due to its growth into the chest wall.

This method is better than plain mammography because mammography may have layers of tissue in the image, causing a small tumor not to be visible.

The installations for performing computed tomography are similar to those used for magnetic resonance imaging.

During a computed tomography scan, the patient lies down on a special plane, which smoothly gradually enters the cylindrical chamber where the X-ray emitter and sensor are located. As each slice is imaged, the emitter and probe make an arc around the area of ​​the patient that needs to be examined. Information from the sensor immediately enters the computer, where it is processed, combined with other images, and the result is a complete picture of the layer of a particular organ at a certain depth.

On average, the procedure takes from 30 to 60 minutes, but can reach 2 hours. It depends on the scope of the study.

Possible complications of CT scan

TO possible complications Computed tomography scans indicate the development of claustrophobia in some patients. In this case, it is recommended to prescribe sedatives before the study. In addition, with numerous x-ray (including tomographic) research methods there is a slight risk of developing malignant tumors.

Computed tomography is contraindicated during pregnancy.

Magnetic resonance imaging – MRI

Magnetic resonance imaging is a method of examining the mammary glands using powerful magnetic field. In this case, the mammary glands are irradiated electromagnetic waves in a strong magnetic field. The principle of the method is that this releases electromagnetic energy, which is then recorded using sensors and subjected to computer processing.

Advantages of magnetic resonance imaging:

• allows you to identify a palpable tumor in women, in cases where it is not detected by mammography or ultrasound.
• Allows you to identify pathological changes in the case of high density of mammary gland tissue.
• allows screening of young women at high risk of developing breast cancer due to family history or the presence of an abnormal gene.
• Sometimes magnetic resonance imaging successfully detects a tumor in women with enlarged axillary lymph nodes when the doctor cannot feel the tumor in the thickness of the breast or it is not visible on mammography. In such cases, where mastectomy is usually recommended, MRI can accurately reveal the location of the tumor in the breast. This allows you to avoid removing the entire gland and limit yourself to only a lumpectomy (removal of the tumor) followed by radiation therapy.
• Helps determine which area is limited cancer tumor, its prevalence in neighboring areas. This influences the choice of surgical treatment tactics, since if the tumor is widespread and multicentric, mastectomy is recommended. This is especially true for patients with invasive lobular carcinoma, since the form of cancer most often tends to be widespread.
• Helps in the assessment of scar tissue in the thickness of the mammary glands, which allows you to monitor the area where the lumpectomy was performed for the presence of early relapses.
• Capable of detecting silicone leakage from a breast implant, as this test method can easily distinguish silicone gel from normal surrounding tissue.
• In the case of metastatic breast cancer, magnetic resonance imaging helps examine other areas of the patient's body for metastases and changes in organs. For example, if in this case the patient began to experience back pain, weakness in the arms and legs, which is a possible sign of cancer metastasis to the spinal cord, a magnetic resonance imaging study of the spine is performed.

Before conducting a magnetic resonance examination, the doctor finds out whether there are any metal objects in the patient’s body, for example, artificial heart pacemakers, artificial metal joints. For such patients, magnetic resonance imaging is contraindicated. In addition, immediately before the examination procedure, a woman must remove all metal objects from herself - jewelry, clothes with metal buttons, etc.

Magnetic resonance imaging is carried out in a special narrow cylindrical chamber. As a result, some patients may experience claustrophobia when in confined spaces. Therefore, they are given a sedative if necessary.

How is magnetic resonance imaging performed?

The patient is placed in a strong magnetic field and exposed to electromagnetic radiation. The resulting electromagnetic energy is processed on a computer. This allows the milk tissue to be layered from different positions and angles. The magnetic field knocks out atomic particles in the tissues - protons, which are then accelerated by electromagnetic radiation and produce signals. These signals are received by sensors and further processed by computer. The result is a very clear image, allowing you to see fine details.

However, the magnetic resonance imaging method also has its drawbacks. First of all, this diagnostic method is expensive. Not all medical centers (even large ones) have equipment for this study. In addition, very often strange findings are found on magnetic resonance imaging.

Magnetic resonance imaging also cannot detect calcifications. In addition, the powerful magnetic field and electromagnetic radiation used in magnetic resonance imaging can damage equipment such as artificial driver rhythm. Therefore, magnetic resonance imaging cannot serve as a diagnostic screening method.

Positron emission tomography

Positron emission tomography is a radionuclide tomographic method for studying internal organs. Positron emission tomography is successfully used in the diagnosis of patients with cancer metastases. The method is especially effective for assessing the condition of lymph nodes.

The positron emission tomography method is based on the fact that a special radiopharmaceutical is injected into the tissue. It contains radionuclides characterized by so-called positron beta decay. After the radiopharmaceutical has been administered, so-called “gamma quanta” are registered.

As already indicated, for tumor cells characterized by increased metabolism. this leads to the fact that they absorb the injected radiopharmaceutical from the blood faster and more strongly. Once the radioactive substance enters the tumor cell, its decay begins. During decay, special particles (quanta) are formed, which are recorded using special equipment. This method allows you to determine the area of ​​suspicious activity of cancer cells.

The positron emission tomography method allows us to clarify the following questions:

• Whether tumor cells remain after radiation therapy or chemotherapy.
• Is there spread of tumor cells to the lymph nodes?

Unfortunately, positron emission tomography also has disadvantages: this method can only be used to detect small tumors. In addition, positron emission tomography is a rather expensive diagnostic method; it is not available in all medical centers.