Cosmetic Filler and PET Positivity: The Risk of a False Positive

Abstract

ObjectiveTo discuss a case of hyaluronic acid filler displaying as PET avid resulting in a false positive for local recurrence and review of the literature of how filler presents on PET.Study DesignCase report and literature review.MethodsRetrospective case review of a patient with angiosarcoma with PET‐MRI positivity after hyaluronic acid filler injection. Review of the literature was performed.ResultsA 49‐year‐old female with low grade angiosarcoma of the right cheek pT1N0M0 was treated with wide local excision and staged reconstruction with cervicofacial advancement flap with subsequent adjuvant radiation therapy. Surveillance PET/MRI scans were conducted every 3 months. After one year without recurrence, HA injectable filler was offered to correct resultant right facial soft tissue defect. The patient proceeded with HA filler and was counseled on the risk of local increased SUV on imaging. Her PET/MRI 3 months later revealed postsurgical changes in the right premaxillary soft tissues with associated low‐grade hypermetabolism with max SUV 1.8, which elevated from prior max SUV 0.9. Contralateral left maxillary soft tissues revealed max SUV 0.8. Biopsy was initially favored for concern of local recurrence until the potential for filler to be associated with elevated SUV was discussed. Further evaluation with MRI showed diffusely increased T2 signal with some trace enhancement in the region of PET activity, confirming that findings were consistent with HA filler augmentation per the neuroradiologist team.ConclusionsFillers, including hyaluronic acid, are associated with elevated SUV on PET‐CT. Otolaryngologists should be aware of these features to improve patient counseling, avoid unnecessary procedures, and reduce patient anxiety. Laryngoscope, 2023

18F-FDG PET-CT Scans in Oncology Patients Treated with Hyaluronic Acid Filler: Not Always a Pitfall

“…Recently, Eitan et al reported the case of a 49-year-old female who received HA filler injections to correct soft tissue defect following wide local excision of a low-grade angiosarcoma on the right cheek. Her PET-MRI 3 months later revealed low-grade hypermetabolism in the right maxillary region, leading to concerns of local recurrence [ 15 ]. The presence of fillers, commonly linked to local inflammatory responses, often leads to false positive PET findings suggestive of tumor recurrence or metastases potentially leading to unnecessary procedures and anxiety for patients [ 16 ].…”