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Case Series
Incidental hip lesions on fluorodeoxyglucose-positron emission tomography during breast cancer staging: Addressing false positives in clinical practice
1 Medical Oncology Unit, Royal Hobart Hospital, Tasmania, Australia
2 Icon Cancer Centre, Hobart, Tasmania, Australia
3 General Surgery Unit, Royal Hobart Hospital, Tasmania, Australia
4 Nuclear Medicine Unit, Royal Hobart Hospital, Tasmania, Australia
Address correspondence to:
Louise M Nott
Medical Oncology Unit, Royal Hobart Hospital, Tasmania, Australia; Icon Cancer Centre, Hobart, Tasmania,
Australia
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Article ID: 100143Z10AW2025
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Awad AR, Pearson EJ, Moldovan CA, Nott LM, Mills JK, Mackie GC. Incidental hip lesions on fluorodeoxyglucose-positron emission tomography during breast cancer staging: Addressing false positives in clinical practice. J Case Rep Images Oncology 2025;11(1):14–19.ABSTRACT
Introduction: Fluorodeoxyglucose-positron emission tomography-computed tomography (FDG-PET/CT) is increasingly used in breast cancer (BC) staging due to its high sensitivity for detecting extra-axillary lymph nodes and distant metastases. This hybrid imaging modality is particularly valuable for its ability to identify metastases not readily detected by conventional methods like CT and whole-body bone scan (WBBS). However, FDG-PET/CT has limitations, especially with lower-proliferative, low-grade tumors, and well-differentiated luminal BC subtypes, which may show reduced FDG uptake. Although FDG-PET/CT generally has significantly fewer false positives (FPs) than standard imaging, FPs on FDG-PET/CT can still cause patient anxiety and treatment initiation delays.
Case Series: In our case series, we highlight three breast cancer patients who presented with FDG-PET/CT avid hip lesions which were reported as possible metastatic disease but on further investigation were all found to be histologically proven benign false positives (FPs). These findings underscore the need for careful interpretation, as solitary FDG-avid lesions can mimic metastatic disease, potentially leading to unnecessary anxiety, additional diagnostic procedures, and delays and significant alterations in treatment. When clinical history, examination, and imaging modalities like magnetic resonance imaging (MRI) cannot definitively diagnose a lesion, histopathological confirmation becomes crucial. Accurate diagnosis and staging, including biopsy, if necessary, are essential for determining the appropriate first-line systemic treatment for each patient.
Conclusion: Ultimately, FDG-PET/CT enhances BC staging by improving detection accuracy across tumor phenotypes and grades; however, it requires careful interpretation and a multidisciplinary approach to prevent overtreatment and ensure the best patient outcomes.
Keywords: Bone metastases, Breast cancer, Diagnostic accuracy, False positives, FDG-PET/CT, Hip lesions, Histopathological confirmation, Staging
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Author Contributions
Ahmed R Awad - Substantial contributions to conception and design, Acquisition of data, Analysis of data, Interpretation of data, Drafting the article, Revising it critically for important intellectual content, Final approval of the version to be published
Erin J Pearson - Substantial contributions to conception and design, Acquisition of data, Analysis of data, Interpretation of data, Drafting the article, Revising it critically for important intellectual content, Final approval of the version to be published
Cristina A Moldovan - Substantial contributions to conception and design, Acquisition of data, Analysis of data, Interpretation of data, Drafting the article, Revising it critically for important intellectual content, Final approval of the version to be published
Louise M Nott - Substantial contributions to conception and design, Acquisition of data, Analysis of data, Interpretation of data, Drafting the article, Revising it critically for important intellectual content, Final approval of the version to be published
Jane K Mills - Substantial contributions to conception and design, Acquisition of data, Analysis of data, Interpretation of data, Drafting the article, Revising it critically for important intellectual content, Final approval of the version to be published
Gavin C Mackie - Substantial contributions to conception and design, Acquisition of data, Analysis of data, Interpretation of data, Drafting the article, Revising it critically for important intellectual content, Final approval of the version to be published
Guaranter of SubmissionThe corresponding author is the guarantor of submission.
Source of SupportNone
Consent StatementWritten informed consent was obtained from the patient for publication of this article.
Data AvailabilityAll relevant data are within the paper and its Supporting Information files.
Conflict of InterestAuthors declare no conflict of interest.
Copyright© 2025 Ahmed R Awad et al. This article is distributed under the terms of Creative Commons Attribution License which permits unrestricted use, distribution and reproduction in any medium provided the original author(s) and original publisher are properly credited. Please see the copyright policy on the journal website for more information.
