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Munenobu Nogami1,2, Tetsuya Tsujikawa1,3, Hiroyuki Maeda4

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COVID-19 vaccination can cause false positives on [18F]FDG PET scans for breast cancer patients. [18F]FES PET can help differentiate true metastatic lymph nodes from vaccine-related changes in ER-positive breast cancer.

Keywords:
COVID-19FES PETbreast cancerlymphadenopathyvaccination

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Area of Science:

  • Oncology
  • Nuclear Medicine
  • Radiology

Background:

  • COVID-19 vaccination is associated with temporary hypermetabolic lymphadenopathy, potentially causing false-positive findings on [18F]FDG PET scans.
  • This diagnostic dilemma complicates the staging and management of patients, particularly those with estrogen-receptor (ER)-positive breast cancer.

Observation:

  • Two cases of ER-positive breast cancer patients who underwent COVID-19 vaccination are presented.
  • [18F]FDG PET showed increased uptake in axillary lymph nodes, mimicking metastatic disease.
  • Subsequent [18F]FES PET imaging successfully identified axillary lymph node metastasis.

Findings:

  • [18F]FES PET demonstrated its utility in accurately detecting axillary lymph node metastasis in COVID-19-vaccinated patients with ER-positive breast cancer.
  • This study highlights the potential of [18F]FES PET to resolve diagnostic ambiguities caused by vaccine-associated lymphadenopathy.
  • The findings suggest [18F]FES PET can reliably identify true metastatic lymph nodes irrespective of vaccination status.

Implications:

  • [18F]FES PET imaging offers a valuable tool for improving the accuracy of breast cancer staging in vaccinated individuals.
  • This technique can aid clinicians in making more informed treatment decisions by distinguishing metastatic disease from benign vaccine responses.
  • The study underscores the importance of considering vaccination status in the interpretation of PET imaging findings for breast cancer patients.