Early detection of SARS-CoV-2 from staging PET-CT
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REVIEW
Early detection of SARS-CoV-2 from staging PET-CT Mohamed H. Khattab 1 & Alexander D. Sherry 2
&
Aaron C. Jessop 3 & Kristen K. Ciombor 4 & Bapsi Chakravarthy 1
Received: 15 June 2020 / Accepted: 24 September 2020 # Springer-Verlag GmbH Germany, part of Springer Nature 2020
Abstract Objective SARS-CoV-2 infection may manifest with minimal or no clinical symptoms. However, signs of infection may appear on routine imaging obtained in the care of patients with cancer. The management of patients planned for chemoradiation with asymptomatic or mildly symptomatic SARS-CoV-2 infection is uncertain. Methods Here, we present a case study of a mildly symptomatic patient with anal cancer diagnosed with SARS-CoV-2 from a staging PET-CT scan. Results PET-CT scan for anal cancer staging demonstrated pulmonary avidity suspicious for an infectious, rather than malignant, process. In the setting of these imaging findings and new-onset anosmia, viral polymerase chain reaction was ordered and found to be positive for SARS-CoV-2. To avoid myelosuppression in the setting of active infection, planned chemoradiation was delayed until cessation of viral shedding. Conclusion In the COVID-19 era, oncologists obtaining routine staging imaging should have high diagnostic suspicion for subclinical SARS-CoV-2 infection. To avoid precipitating severe pneumonia and hospitalization, multidisciplinary discussion with risk-benefit analysis is recommended before initiating immunosuppressive therapies such as chemoradiation. Keywords COVID-19 . Coronavirus . Anal cancer . Cancer staging . Chemoradiation
Patient history and presentation A 61-year-old female with biopsy-proven anal squamous cell carcinoma was referred for staging positron emission tomography–computed tomography (PET-CT) to rule out metastatic disease, prior to planned definitive chemotherapy and radiation. Her anal cancer had been detected on routine screening colonoscopy. She denied having any cough, fever, shortness of breath, or any gastrointestinal symptoms. She did recall a peculiar, subjective anosmia during the prior week, * Mohamed H. Khattab [email protected] 1
Department of Radiation Oncology, Vanderbilt-Ingram Cancer Center, Vanderbilt University Medical Center, 2220 Pierce Avenue, Preston Research Building, Rm B-1003, Nashville, TN 37232-5671, USA
2
Vanderbilt University School of Medicine, Nashville, TN, USA
3
Division of Nuclear Medicine, Department of Radiology and Radiological Sciences, Vanderbilt University Medical Center, Nashville, TN, USA
4
Division of Hematology and Oncology, Department of Medicine, Vanderbilt University Medical Center, Nashville, TN, USA
although she was without congestion or nasal obstruction. At presentation, she was largely asymptomatic and was unconcerned regarding her reduced ability to smell. PET-CT for oncologic staging demonstrated fluorodeoxyglucose-avid multifocal lower lung, rounded, peripheral ground-glass nodules within the right lower, right middle, and left lower lobes with several opacities demonstrating
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