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      Novel 68Ga-FAPI PET/CT Offers Oncologic Staging Without COVID-19 Vaccine–Related Pitfalls

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          Abstract

          In the setting of ongoing coronavirus disease 2019 vaccination, vaccine-related tracer uptake in locoregional lymph nodes has become a well-known issue in tumor staging by 18F-FDG PET/CT. 68Ga-fibroblast-activation protein inhibitor (FAPI) PET/CT is a new oncologic imaging tool that may overcome this limitation. Methods: We assessed postvaccine head-to-head and same-day 18F-FDG and 68Ga-FAPI-46 PET/CT findings in a series of 11 patients from a large, prospective imaging registry. All patients with documented tracer uptake in locoregional lymph nodes on PET/CT or PET/MRI, after vaccination within 6 wk, were eligible for investigation. Result: Significant visual lymph node uptake adjacent to the injection site was noted in 11 of 11 (100%) patients with 18F-FDG PET/CT, versus 0 of 11 (0%) with 68Ga-FAPI PET/CT. 18F-FDG detected 73% and 68Ga-FAPI PET/CT 94% of all tumor lesions. Conclusion: In this case-series study, 68Ga-FAPI showed its potential to avoid 18F-FDG PET/CT postvaccination pitfalls and presented superior tumor localization.

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          Analyses of Risk, Racial Disparity, and Outcomes Among US Patients With Cancer and COVID-19 Infection

          QuanQiu Wang, Nathan Berger, Rong Xu (2020)
          Patients with specific cancers may be at higher risk than those without cancer for coronavirus disease 2019 (COVID-19) and its severe outcomes. At present, limited data are available on the risk, racial disparity, and outcomes for COVID-19 illness in patients with cancer.
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            Lymphadenopathy in COVID-19 Vaccine Recipients: Diagnostic Dilemma in Oncology Patients

            Can Ozutemiz, Luke A. Krystosek, An Church … (2021)
            Abstract We present five cases of axillary lymphadenopathy which occurred after COVID-19 vaccination and that mimicked metastasis in oncologic patients. Initial radiologic diagnosis raised concerns for metastasis. However, further investigation revealed that patients received COVID-19 vaccinations in the ipsilateral arm prior to imaging. In two cases, lymph node biopsy confirmed vaccination related reactive lymphadenopathy. Ipsilateral axillary swelling / lymphadenopathy was reported based on symptoms and physical examination in COVID-19 vaccine trials. Knowledge of the potential for COVID-19 vaccine-related ipsilateral adenopathy is necessary to avoid unnecessary biopsy and change in therapy.
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              Multidisciplinary Recommendations Regarding Post-Vaccine Adenopathy and Radiologic Imaging: Radiology Scientific Expert Panel

              Anton Becker, Rocio Perez-Johnston, Sona A Chikarmane … (2021)
              Vaccination-associated adenopathy is a frequent imaging finding after administration of COVID-19 vaccines that may lead to a diagnostic conundrum in patients with manifest or suspected cancer, in whom it may be indistinguishable from malignant nodal involvement. To help the medical community address this concern in the absence of studies and evidence-based guidelines, this paper offers recommendations developed by a multidisciplinary panel of experts from three of the leading tertiary care cancer centers in the United States. According to these recommendations, some routine imaging examinations, such as those for screening, should be scheduled before or at least 6 weeks after the final vaccination dose to allow for any reactive adenopathy to resolve. However, there should be no delay of other clinically indicated imaging (e.g., for acute symptoms, short-interval treatment monitoring, urgent treatment planning or complications) due to prior vaccination. The vaccine should be administered on the side contralateral to the primary or suspected cancer, and both doses should be administered in the same arm. Vaccination information (date(s) administered, injection site(s), laterality, and type of vaccine) should be included in every pre-imaging patient questionnaire, and this information should be made readily available to interpreting radiologists. Clear and effective communication between patients, radiologists, referring physician teams and the general public should be considered of the highest priority when managing adenopathy in the setting of COVID-19 vaccination. Summary COVID-19-vaccination–related adenopathy is a frequent imaging finding that may lead to a diagnostic conundrum in patients with manifest or suspected cancer, in whom it may be indistinguishable from malignant nodal involvement. This special report offers recommendations developed by a multidisciplinary panel of experts from three of the leading tertiary care cancer centers in the United States.
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                Author and article information

                Journal
                Journal ID (nlm-ta): J Nucl Med
                Journal ID (iso-abbrev): J Nucl Med
                Journal ID (hwp): jnumed
                Journal ID (publisher-id): jnm
                Title: Journal of Nuclear Medicine
                Publisher: Society of Nuclear Medicine
                ISSN (Print): 0161-5505
                ISSN (Electronic): 1535-5667
                Publication date (Print): March 2023
                Publication date PMC-release: March 2023
                Volume: 64
                Issue: 3
                Pages: 368-371
                Affiliations
                [1 ]Department of Nuclear Medicine, West German Cancer Center, University of Duisburg–Essen, Essen, Germany;
                [2 ]German Cancer Consortium, Partner Site Essen University Hospital, and German Cancer Research Center, Essen, Germany;
                [3 ]Institute for AI in Medicine, University Medicine Essen, Essen, Germany;
                [4 ]Bridge Institute of Experimental Tumor Therapy, West German Cancer Center, Essen University Hospital, Essen, Germany;
                [5 ]Department of Diagnostic and Interventional Radiology and Neuroradiology, Essen University Hospital, University of Duisburg–Essen, Essen, Germany; and
                [6 ]Department of Medical Oncology, West German Cancer Center, Essen University Hospital, Essen, Germany
                Author notes
                For correspondence or reprints, contact Wolfgang P. Fendler ( wolfgang.fendler@ 123456uk-essen.de ).

                Published online Nov. 17, 2022.

                Article
                Publisher ID: 264872
                DOI: 10.2967/jnumed.122.264872
                PMC ID: 10071804
                PubMed ID: 36396454
                SO-VID: 6b1a99cc-ab69-4953-a052-0cf5e839c763
                Copyright © © 2023 by the Society of Nuclear Medicine and Molecular Imaging.
                License:

                Immediate Open Access: Creative Commons Attribution 4.0 International License (CC BY) allows users to share and adapt with attribution, excluding materials credited to previous publications. License: https://creativecommons.org/licenses/by/4.0/. Details: http://jnm.snmjournals.org/site/misc/permission.xhtml.

                History
                Date received : 05 September 2022
                Date revision received : 27 October 2022
                Page count
                Pages: 4
                Categories
                Subject: Brief Communication

                Keywords: pet,pet/ct,covid-19,tumor staging,vaccine-related pitfalls
                Data availability:
                Keywords: pet, pet/ct, covid-19, tumor staging, vaccine-related pitfalls

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