Extensive Tattoos Mimicking Lymphatic Metastasis on Positron Emission Tomography Scan in a Patient With Cervical Cancer

• Published in: Obstetrics and gynecology (New York. 1953) Vol. 126; no. 1; pp. 182 - 185
• Main Authors: Grove, Narine, Zheng, Ma, Bristow, Robert E, Eskander, Ramez N
• Format: Journal Article
• Language: English
• Published: United States 01.07.2015
• Subjects: Adult; Carcinoma, Squamous Cell - diagnostic imaging; Carcinoma, Squamous Cell - pathology; False Positive Reactions; Female; Fluorodeoxyglucose F18; Humans; Lymphatic Metastasis; Positron-Emission Tomography; Radiopharmaceuticals; Tattooing; Tomography, X-Ray Computed; Uterine Cervical Neoplasms - diagnostic imaging; Uterine Cervical Neoplasms - pathology
• ISSN: 0029-7844; 1873-233X
• DOI: 10.1097/AOG.0000000000000701

Positron emission tomography (PET) fused with computed tomography (CT) imaging is common in the clinical assessment of patients with locally advanced cervical cancer. Limitations to the utilization and interpretation of PET-CT scans in patients with cervical cancer have been described, including false-positive findings secondary to tattoo ink. A 32-year-old woman presented with clinical stage 1B1 cervical cancer and extensive tattoos of the lower extremities. Preoperative PET-CT scan identified two ileac lymph nodes with increased fluorine-18-deoxyglucose uptake suspicious for metastatic disease. At the time of surgical resection, bilateral pigmented lymph nodes were identified with histologic examination showing deposition of tattoo ink and no malignant cells. Physicians should be cognizant of the possible effects of tattoos on PET-CT findings while counseling patients and formulating a treatment program.