Unveiling the Diagnostic Mystery: 18F-FDG PET and Bone Scan Negative in Bone Metastases of Lobular Breast Cancer: A Case Report

Sharjeel Usmani; Khulood Al Riyami; Anjali Jain; Asiya Al Busaidi; Paul Dumasig; Vipin V Jayakrishnan; Subhash Kheruka; Najeeb Ahmed

doi:10.4274/mirt.galenos.2025.75875

Abstract

Identifying osseous metastases by imaging is essential and may be challenging in patients with lobular breast cancer. We present a case of a 66-year-old woman with lobular breast cancer who underwent ¹⁸F- fluorodeoxyglucose positron emission tomography/computed tomography (FDG PET/CT) for staging purposes. ¹⁸F-FDG PET/CT reveals minimal FDG uptake in the primary tumor cells. Prominent sclerotic lesions with low FDG avidity are seen in the spinal and pelvic bones. The subsequent Tc-99m methylene diphosphonate bone scan is unremarkable. The magnetic resonance imaging (MRI) reveals bone metastases. MRI may be beneficial in invasive lobular carcinoma. MRI facilitates improved metastatic evaluation, especially in bone-only and bone-predominant metastatic malignancies, when assessment with ¹⁸F-FDG PET/CT may be difficult and constrained.

Keywords:

Lobular breast cancer, 18F-FDG PET/CT, osseous metastases, MRI

Figure 1, Figure 2

Ethics

Informed Consent: The consent was obtained for image use.

Authorship Contributions

Surgical and Medical Practices: S.U., K.A.R., A.J., A.A.B., N.A., Concept: S.U., K.A.R., A.J., Design: S.U., V.V.J., S.K., Data Collection or Processing: S.U., K.A.R., A.J., A.A.B., P.D., V.V.J., S.K., N.A., Analysis or Interpretation: S.U., A.J., A.A.B., Literature Search: S.U., N.A., Writing: S.U., K.A.R., N.A.

Conflict of Interest: No conflicts of interest were declared by the authors.

Financial Disclosure: The authors declare that this study has received no financial support.

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