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

Grove, Narine MD; Zheng, Ma MD; Bristow, Robert E. MD; Eskander, Ramez N. MD

doi: 10.1097/AOG.0000000000000701
Contents: Case Report

BACKGROUND: 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.

CASE: 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.

CONCLUSION: Physicians should be cognizant of the possible effects of tattoos on PET-CT findings while counseling patients and formulating a treatment program.

Tattoos in patients with cervical cancer can result in false-positive lymph node metastases on positron emission tomography scan, which affects counseling and treatment.

Division of Gynecology Oncology, Department of Obstetrics and Gynecology, and the Department of Anatomic Pathology, The University of California, Irvine Medical Center, Orange, California.

Corresponding author: Ramez N. Eskander, MD, Department of Obstetrics and Gynecology, Division of Gynecologic Oncology, The University of California, Irvine Medical Center, Orange, CA 92868; e-mail:

Financial Disclosure The authors did not report any potential conflicts of interest.

© 2015 by The American College of Obstetricians and Gynecologists. Published by Wolters Kluwer Health, Inc. All rights reserved.