When a California woman with cervical cancer underwent a body image scan, doctors noticed bright areas in her lymph nodes, suggesting her cancer had spread. But it was only after surgery to treat the cancer that they realized the real reason for those bright spots: her tattoos.
The 32-year-old woman with four children had recently been diagnosed with cervical cancer. In November 2012, her doctors requested the imaging scan to check to see if the cancer had spread (metastasized) to other parts of her body.
Findings of possible metastatic disease on PET scans can certainly change management," Eskander said. "We want to make sure that people understand that these false positives could arise in patients that have tattoos," he said.
The researchers did find that the woman had a small number of cancer cells in one of her pelvic lymph nodes, a condition that doctors call a "micro metastasis." But this micro metastasis was too small to have shown up on the PET scan, so it was only by chance that the doctors found it, Eskander said.
The type of scan the doctors wanted was a PET/CT fusion scan, which combines technology from both PET and CT scans, and requires that patients receive an injection of a radioactive tracer that makes tumors appear as bright spots on the scan.
The scan showed not only the woman's cervical tumor, but also bright spots on the lymph nodes in her pelvis, which looked suspiciously like cancer metastases, the researchers wrote in their report of her case, published in the journal Obstetrics and Gynecology.
To treat her cervical cancer, the woman had surgery to remove her uterus, cervix, fallopian tubes and pelvic lymph nodes.
But when doctors later examined cells from the woman's lymph nodes under a microscope, they saw that the cells contained deposits of tattoo ink — not cancer. The woman had more than 14 tattoos on her legs.
"Those lymph nodes that were lighting up brightly on the PET scan were doing so because of the tattoo pigment that was in the lymph nodes," said study co-author Dr. Ramez Eskander, assistant clinical professor of gynecologic oncology at the University of California, Irvine Medical Center, who treated the woman.
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