Letter to the Editor
Strange body reaction by Surgicel® simulating lymph node relapse on PET/CT after lung cancer surgery: 3 new cases
Reacción de cuerpo extraño por Surgicel® que simula recaída ganglionar en PET/TC tras cirugía por cáncer de pulmón: 3 nuevos casos
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"apellidos" => "Murias Loza" ] ] ] ] ] "idiomaDefecto" => "en" "Traduccion" => array:1 [ "es" => array:9 [ "pii" => "S2253654X21000706" "doi" => "10.1016/j.remn.2021.03.009" "estado" => "S300" "subdocumento" => "" "abierto" => array:3 [ "ES" => false "ES2" => false "LATM" => false ] "gratuito" => false "lecturas" => array:1 [ "total" => 0 ] "idiomaDefecto" => "es" "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S2253654X21000706?idApp=UINPBA00004N" ] ] "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S2253808921000677?idApp=UINPBA00004N" "url" => "/22538089/0000004000000003/v1_202104250727/S2253808921000677/v1_202104250727/en/main.assets" ] "en" => array:15 [ "idiomaDefecto" => true "cabecera" => "<span class="elsevierStyleTextfn">Letter to the Editor</span>" "titulo" => "Strange body reaction by Surgicel® simulating lymph node relapse on PET/CT after lung cancer surgery: 3 new cases" "tieneTextoCompleto" => true "saludo" => "Dear Director:" "paginas" => array:1 [ 0 => array:2 [ "paginaInicial" => "202" "paginaFinal" => "203" ] ] "autores" => array:1 [ 0 => array:4 [ "autoresLista" => "J. López Sánchez, M.T. Gómez Hernández" "autores" => array:2 [ 0 => array:3 [ "nombre" => "J." "apellidos" => "López Sánchez" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">a</span>" "identificador" => "aff0005" ] ] ] 1 => array:4 [ "nombre" => "M.T." "apellidos" => "Gómez Hernández" "email" => array:1 [ 0 => "mtgh@usal.es" ] "referencia" => array:2 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">b</span>" "identificador" => "aff0010" ] 1 => array:2 [ "etiqueta" => "*" "identificador" => "cor0005" ] ] ] ] "afiliaciones" => array:2 [ 0 => array:3 [ "entidad" => "Departamento de Cirugía General y del Aparato Digestivo, Hospital Universitario de Salamanca, Salamanca, Spain" "etiqueta" => "a" "identificador" => "aff0005" ] 1 => array:3 [ "entidad" => "Departamento de Cirugía Torácica, Hospital Universitario de Salamanca, Salamanca, Spain" "etiqueta" => "b" "identificador" => "aff0010" ] ] "correspondencia" => array:1 [ 0 => array:3 [ "identificador" => "cor0005" "etiqueta" => "⁎" "correspondencia" => "Corresponding author." ] ] ] ] "titulosAlternativos" => array:1 [ "es" => array:1 [ "titulo" => "Reacción de cuerpo extraño por Surgicel® que simula recaída ganglionar en PET/TC tras cirugía por cáncer de pulmón: 3 nuevos casos" ] ] "resumenGrafico" => array:2 [ "original" => 0 "multimedia" => array:8 [ "identificador" => "fig0005" "etiqueta" => "Fig. 1" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr1.jpeg" "Alto" => 761 "Ancho" => 1505 "Tamanyo" => 178033 ] ] "detalles" => array:1 [ 0 => array:3 [ "identificador" => "at0005" "detalle" => "Fig. " "rol" => "short" ] ] "descripcion" => array:1 [ "en" => "<p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">Intraoperative view of the application of Surgicel® in lymphadenectomy beds and 18 F-FDG-PET/TC images during postoperative follow-up of patient 1 (A/B), patient 2 (C/D) and patient 3 (E/F).</p>" ] ] ] "textoCompleto" => "<span class="elsevierStyleSections"><p id="par0005" class="elsevierStylePara elsevierViewall">We present three clinical cases with false-positive results from the positron emission tomography with fluorine-18 Fluorodeoxyglucose integrated with computed tomography (18-F-FDG-PET/CT) during the follow-up after lung resection for lung cancer in relation to foreign body reaction after intraoperative application of regenerated oxidized cellulose (Surgicel®) at the level of the lymphadenectomy beds simulating a lymph node relapse. Our objective is to warn about the possibility of false positives in oncological follow-up with PET/CT in relation to foreign body reactions by Surgicel®.</p><p id="par0010" class="elsevierStylePara elsevierViewall">Case 1. A 59-year-old former smoker male with a history of ischemic heart disease who underwent a left lower lobectomy and systematic lymphadenectomy through a robotic approach (RATS) for a stage pT2aN1M0 squamous cell carcinoma, to whom Surgicel® was applied in areas 5 and 7 after lymphadenectomy (<a class="elsevierStyleCrossRef" href="#fig0005">Fig. 1</a>A). Eight months after surgery, he presented radiological and metabolic suspicion of lymph node relapse due to a 16 mm lesion with SUVmax of 13.4 in the subaortic region (<a class="elsevierStyleCrossRef" href="#fig0005">Fig. 1</a>B). A biopsy of the lesion was performed by videothoracoscopy, the final histological analysis resulting in a necrotic reaction associated with acellular material.</p><elsevierMultimedia ident="fig0005"></elsevierMultimedia><p id="par0015" class="elsevierStylePara elsevierViewall">Case 2. A 54-year-old, former smoker and asthmatic male who underwent right lower lobectomy and systematic lymphadenectomy via RATS for a stage pT2aN0M0 squamous cell carcinoma. In the same way, Surgicel® was placed in the lymphadenectomy bed of area 7 (<a class="elsevierStyleCrossRef" href="#fig0005">Fig. 1</a>C). One year later, he presented suspicion of lymph node relapse due to a 40 mm mass in the subcarinal region with an SUVmax of 17 (<a class="elsevierStyleCrossRef" href="#fig0005">Fig. 1</a>D). Ultrasound-guided transbronchial aspiration puncture (EBUS-TBNA) was performed with a negative result for malignancy and subsequent biopsy of the tumor by thoracotomy, with a definitive diagnosis of fibrohistiocytic reaction, with no evidence of malignancy.</p><p id="par0020" class="elsevierStylePara elsevierViewall">Case 3. A 63-year-old woman with a history of epilepsy, COPD, and diabetes mellitus who underwent middle lobectomy and systematic lymphadenectomy via RATS for a stage pT3N0M0 squamous cell carcinoma. Surgicel® was placed in a 4R area lymphadenectomy bed (<a class="elsevierStyleCrossRef" href="#fig0005">Fig. 1</a>E). Three months later, he presented radiological and metabolic suspicion of lymph node relapse at the right paratracheal region (SUVmax: 3.8) (<a class="elsevierStyleCrossRef" href="#fig0005">Fig. 1</a>F). EBUS-TBNA of region 4R was performed, obtaining a fibrinaceous material without lymph node cellularity, negative for malignancy.</p><p id="par0025" class="elsevierStylePara elsevierViewall">Even though PET/CT is the most sensitive non-invasive method for detecting recurrences in lung cancer,<a class="elsevierStyleCrossRef" href="#bib0005"><span class="elsevierStyleSup">1</span></a> it presents a significant false positive rate.<a class="elsevierStyleCrossRef" href="#bib0010"><span class="elsevierStyleSup">2</span></a> Thus, certain surgical materials can cause foreign body reactions and granulomas that simulate loco-regional recurrences.<a class="elsevierStyleCrossRef" href="#bib0015"><span class="elsevierStyleSup">3</span></a> Recently, Díaz et al.<a class="elsevierStyleCrossRef" href="#bib0020"><span class="elsevierStyleSup">4</span></a> have described two similar cases of granulomatous reaction secondary to Surgicel® in mediastinal lymphadenopathy, whose diagnosis was made using EBUS-TBNA.</p><p id="par0030" class="elsevierStylePara elsevierViewall">Surgicel® is an absorbable hemostatic composed of regenerated oxidized cellulose whose complete absorption occurs 7–14 days after its application, depending mainly on the amount used.<a class="elsevierStyleCrossRef" href="#bib0025"><span class="elsevierStyleSup">5</span></a> Probably, the decrease in the amount of Surgicel® applied or its removal once adequate hemostasis has been achieved would result in the complete absorption of the exogenous material and in a less inflammatory reaction. Likewise, it would be convenient to keep a record of the use and locations in which this material is used for oncological monitoring.</p><p id="par0035" class="elsevierStylePara elsevierViewall">Despite being an infrequent finding, granulomas due to foreign body reactions derived from the use of hemostatic material, sutures or staples, should be considered in the follow-up of patients operated on for lung cancer. However, we consider that in the event of a pathological uptake of 18F-FDG in oncological follow-up PET, the suspicion of loco-regional recurrence should be considered as the first possibility and should always be verified histologically, in order to avoid unnecessary treatments and complex reoperations.</p></span>" "pdfFichero" => "main.pdf" "tienePdf" => true "NotaPie" => array:1 [ 0 => array:2 [ "etiqueta" => "☆" "nota" => "<p class="elsevierStyleNotepara" id="npar0005">Please cite this article as: López Sánchez J, Gómez Hernández MT. Reacción de cuerpo extraño por Surgicel® que simula recaída ganglionar en PET/TC tras cirugíapor cáncer de pulmón: 3 nuevos casos. Rev Esp Med Nucl Imagen Mol. 2021;40:202–203.</p>" ] ] "multimedia" => array:1 [ 0 => array:8 [ "identificador" => "fig0005" "etiqueta" => "Fig. 1" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr1.jpeg" "Alto" => 761 "Ancho" => 1505 "Tamanyo" => 178033 ] ] "detalles" => array:1 [ 0 => array:3 [ "identificador" => "at0005" "detalle" => "Fig. " "rol" => "short" ] ] "descripcion" => array:1 [ "en" => "<p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">Intraoperative view of the application of Surgicel® in lymphadenectomy beds and 18 F-FDG-PET/TC images during postoperative follow-up of patient 1 (A/B), patient 2 (C/D) and patient 3 (E/F).</p>" ] ] ] "bibliografia" => array:2 [ "titulo" => "References" "seccion" => array:1 [ 0 => array:2 [ "identificador" => "bibs0005" "bibliografiaReferencia" => array:5 [ 0 => array:3 [ "identificador" => "bib0005" "etiqueta" => "1" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "The value of FDG PET/CT in treatment response assessment, follow-up, and surveillance of lung cancer" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:3 [ 0 => "S. 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