A false-positive finding in therapeutic evaluation: hypermetabolic axillary lymph node in a lymphoma patient following FDG extravasation

Wagner, Thomas; Brucher, N.; Julian, Anne; Hitzel, Anne

doi:10.5603/nmr.2011.00025

Cited by 10 publications

(7 citation statements)

References 9 publications

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“…of patients with reported radiation injuryNo. of patients with reported follow-upMost severe injury reported[8–17]33218F-FDG00[18–31]2584 99m Tc bone tracers00[32]3 99m Tc-MAA00[33]1 99m Tc-DMSA00[34, 35]10 99m Tc-DTPA00[36]1 99m Tc-HMPAO00[37]1 99m Tc-MAG300[19, 38, 39]15 99m Tc-pertechnetate00[40, 41]2 99m Tc-sestamibi00[19]38 99m Tc-sulfurcolloid00[19]16 99m Tc-microspheres00[42]1 131 I-iodocholesterol11Erythematous plaque and pruritus.[43–45]12 201 Tl-thallous chloride22Radiation ulcerTotal301633 …”

Section: Resultsmentioning

confidence: 99%

Consequences of radiopharmaceutical extravasation and therapeutic interventions: a systematic review

Pol

Vöö

Bucerius

et al. 2017

Eur J Nucl Med Mol Imaging

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PurposeRadiopharmaceutical extravasation can potentially lead to severe soft tissue damage, but little is known about incidence, medical consequences, possible interventions, and effectiveness of these. The aims of this study are to estimate the incidence of extravasation of diagnostic and therapeutic radiopharmaceuticals, to evaluate medical consequences, and to evaluate medical treatment applied subsequently to those incidents.MethodsA sensitive and elaborate literature search was performed in Embase and PubMed using the keywords “misadministration”, “extravasation”, “paravascular infiltration”, combined with “tracer”, “radionuclide”, “radiopharmaceutical”, and a list of keywords referring to clinically used tracers (i.e. “Technetium-99m”, “Yttrium-90”). Reported data on radiopharmaceutical extravasation and applied interventions was extracted and summarised.ResultsThirty-seven publications reported 3016 cases of diagnostic radiopharmaceutical extravasation, of which three cases reported symptoms after extravasation. Eight publications reported 10 cases of therapeutic tracer extravasation. The most severe symptom was ulceration. Thirty-four different intervention and prevention strategies were performed or proposed in literature.ConclusionsExtravasation of diagnostic radiopharmaceuticals is common. 99mTc, 123I, 18F, and 68Ga labelled tracers do not require specific intervention. Extravasation of therapeutic radiopharmaceuticals can give severe soft tissue lesions. Although not evidence based, surgical intervention should be considered. Furthermore, dispersive intervention, dosimetry and follow up is advised. Pharmaceutical intervention has no place yet in the immediate care of radiopharmaceutical extravasation.

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Section: Resultsmentioning

confidence: 99%

Consequences of radiopharmaceutical extravasation and therapeutic interventions: a systematic review

Pol

Vöö

Bucerius

et al. 2017

Eur J Nucl Med Mol Imaging

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“…18 ). Regardless of intense FDG uptake, each node seems to be normal in size and has a fatty hilum [ 82 ]. A marked tracer distribution within the subcutaneous tissue of the upper limb around the injection site indicates tracer extravasation, even if the patients or the medical staff who administered the tracer have not been aware of it.…”

Section: Uncommon Findings Associated With Fdg Injectionsmentioning

confidence: 99%

FDG–PET findings associated with various medical procedures and treatments

et al. 2022

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Abstract[18F]-fluorodeoxyglucose (FDG) positron emission tomography (PET) is a well-established modality with high sensitivity for the diagnosis and staging of oncologic patients. FDG is taken up by the glucose transporter of the cell membrane and becomes trapped within the cell. In addition to malignant neoplasms, active inflammatory lesions and some kinds of benign tumors also accumulate FDG. Moreover, the degree of uptake into normal organs and tissues depends on various physiological conditions, which is affected by various medical procedures, treatments, and drugs. To avoid misleading interpretations, it is important to recognize possible situations of unexpected abnormal accumulation that mimic tumor lesions. In this review, we present various FDG findings associated with surgical or medical procedures and treatments. Some findings reflect the expected physiological reaction to treatment, and some show inflammation due to prior procedures. Occasionally, FDG–PET visualizes other disorders that are unrelated to the malignancy, which may be associated with the adverse effects of certain drugs that the patient is taking. Careful review of medical records and detailed interviews of patients are thus necessary.

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“…In the same way, axillary lymph nodes can be a source of false-positive results. A usual case is tracer extravasation [29,30]: the lymph node is usually not enlarged and shows an adipose tissue component. In clinical practice, axillary lymph node uptake after treatment should be considered as pathologic only if associated with another abnormal uptake, increasing the rate of true positivity from 20.8 to 79.6%, [31].…”

Section: Other Nonspecific Lymph Nodesmentioning

confidence: 99%

Usual and unusual pitfalls of 18F-FDG-PET/CT in lymphoma after treatment

Dubreuil

Salles

Bozzetto

et al. 2017

Nuclear Medicine Communications

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Fluorine-18-fluorodeoxyglucose (F-FDG) PET/computed tomography (CT) is now a standard of care in initial staging and treatment evaluation of lymphomas. It is also used in the interim evaluation in diffuse large B cell lymphoma and Hodgkin lymphoma. However, several pitfalls may occur during or after treatment, because of the nonspecificity of F-FDG for lymphoma disease and treatment as immunotherapy, thus possibly induces misinterpretation and wrong treatment decision. The aim of this pictorial review is to provide an illustrated tutorial of the most frequent pitfalls found on F-FDG-PET/CT during or after treatment.

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A false-positive finding in therapeutic evaluation: hypermetabolic axillary lymph node in a lymphoma patient following FDG extravasation

Cited by 10 publications

References 9 publications

Consequences of radiopharmaceutical extravasation and therapeutic interventions: a systematic review

Consequences of radiopharmaceutical extravasation and therapeutic interventions: a systematic review

FDG–PET findings associated with various medical procedures and treatments

Usual and unusual pitfalls of 18F-FDG-PET/CT in lymphoma after treatment

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