Strange body reaction by Surgicel® simulating lymph node relapse on PET/CT after lung cancer surgery: 3 new cases

López Sánchez, J.; Gómez Hernández, M.T.

doi:10.1016/j.remnie.2020.10.001

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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" => "Letter to the Editor" "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" => "a" "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" => "b" "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" => "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)." ] ] ] "textoCompleto" => "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®.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.<elsevierMultimedia ident="fig0005"></elsevierMultimedia>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.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.Even though PET/CT is the most sensitive non-invasive method for detecting recurrences in lung cancer,<a class="elsevierStyleCrossRef" href="#bib0005">1</a> it presents a significant false positive rate.<a class="elsevierStyleCrossRef" href="#bib0010">2</a> Thus, certain surgical materials can cause foreign body reactions and granulomas that simulate loco-regional recurrences.<a class="elsevierStyleCrossRef" href="#bib0015">3</a> Recently, Díaz et al.<a class="elsevierStyleCrossRef" href="#bib0020">4</a> have described two similar cases of granulomatous reaction secondary to Surgicel® in mediastinal lymphadenopathy, whose diagnosis was made using EBUS-TBNA.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">5</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.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." "pdfFichero" => "main.pdf" "tienePdf" => true "NotaPie" => array:1 [ 0 => array:2 [ "etiqueta" => "☆" "nota" => "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." ] ] "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" => "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)." ] ] ] "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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"fecha" => "2017" "volumen" => "12" "paginaInicial" => "55" "paginaFinal" => "56" ] ] ] ] ] ] ] ] ] ] ] "idiomaDefecto" => "en" "url" => "/22538089/0000004000000003/v1_202104250727/S2253808920301282/v1_202104250727/en/main.assets" "Apartado" => array:4 [ "identificador" => "22541" "tipo" => "SECCION" "en" => array:2 [ "titulo" => "Letter to the editor" "idiomaDefecto" => true ] "idiomaDefecto" => "en" ] "PDF" => "https://static.elsevier.es/multimedia/22538089/0000004000000003/v1_202104250727/S2253808920301282/v1_202104250727/en/main.pdf?idApp=UINPBA00004N&text.app=https://www.elsevier.es/" "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S2253808920301282?idApp=UINPBA00004N"]

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The Revista Española de Medicina Nuclear e Imagen Molecular (Spanish Journal of Nuclear Medicine and Molecular Imaging), was founded in 1982, and is the official journal of the Spanish Society of Nuclear Medicine and Molecular Imaging, which has more than 700 members. The Journal, which publishes 6 regular issues per year, has the promotion of research and continuing education in all fields of Nuclear Medicine as its main aim. For this, its principal sections are Originals, Clinical Notes, Images of Interest, and Special Collaboration articles. The works may be submitted in Spanish or English and are subjected to a peer review process. In 2009, it became the leading Spanish journal in the field of Medical Imaging on having an Impact Factor , awarded by the Journal Citation Reports.

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