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[Granulation tissue: pitfall in therapy control with F-18-FDG PET after chemotherapy]
J Lorenzen1, M de Wit, R Buchert
1Abteilung für Röntgendiagnostik, Universitätskrankenhaus Eppendorf, Hamburg, Deutschland.
Abstract:
False positive findings in primary tumor and metastasis diagnostics by FDG-PET due to FDG-uptake in inflammatory foci are documented in literature. The demonstrated case reveals that increased uptake of FDG in activated neutrophile granulocytes and macrophages has to be taken into consideration in therapy control under chemotherapy, too. In a 53 year old patient FDG-PET was performed after chemotherapy of an abdominal Non-Hodgkin lymphoma for evaluation of persistent tumor vitality. The margin of the persisting mass showed increased uptake of glucose. Histology documented a necrotic center surrounded by granulation tissue.
Insights
False positive findings on FDG-PET scans can occur due to inflammation. This study highlights that increased FDG uptake in immune cells during chemotherapy requires careful consideration for accurate lymphoma treatment assessment.
Area of Science:
- Oncology
- Nuclear Medicine
- Immunology
Background:
- False positive findings in positron emission tomography (PET) scans using fluorodeoxyglucose (FDG) are often attributed to uptake in inflammatory foci.
- Assessing treatment response in Non-Hodgkin lymphoma (NHL) using FDG-PET requires differentiating tumor activity from inflammatory changes.
Observation:
- A 53-year-old patient with abdominal NHL underwent FDG-PET post-chemotherapy to evaluate persistent tumor vitality.
- The scan revealed increased FDG uptake at the margin of a residual mass.
- Histological examination showed a necrotic center surrounded by granulation tissue.
Findings:
- Activated neutrophils and macrophages can exhibit increased FDG uptake, mimicking residual tumor.
- This heightened uptake in inflammatory cells must be considered during chemotherapy treatment monitoring.
Implications:
- FDG-PET interpretation in lymphoma patients undergoing chemotherapy needs to account for inflammatory responses.
- Accurate assessment of treatment efficacy relies on distinguishing true tumor metabolism from FDG uptake by activated immune cells.