Incidental lung findings suggestive of COVID-19 pneumonia in oncologic PET/CT studies

Aim/Introduction: In Spain COVID-19 pandemia reached its outbreak in March 2020 For some weeks, patients without clinical diagnosis of COVID-19 infection underwent PET/ CT studies for standard indications The aim of this study is to report incidental PET/CT findings suggestive of COVID-19 associated pneumonia in this group of patients, who received medical attention in a third level hospital of Madrid during this 'peak of infection' period Materials and Methods: Whole body PET/CT studies from patients without clinical or microbiological diagnosis of COVID-19 infection, performed from March 3rd to April14th, were retrospectively reviewed by two nuclear medicine experts Lung findings unrelated to their oncologic process or pulmonary chronic disease were noted CT findings were classified in three categories following COVID-19 pneumonia classification for CT (Simpson S and cols, 2020): typical, indeterminate and atypical appearance;all of them were PET positive if they presented pathological radiotracer uptake Final diagnosis was made based on PCR results and clinical follow up Change in the patient management was also recorded Results: 230 whole body PET/CT scans were reviewed 33 of them (14 3%) had lung findings suggestive of COVID-19 associated pneumonia (30 18F-FDG, 3 18F-Fluorocholine) Twelve patients had typical pattern, 15 indeterminate pattern and 6 atypical pattern, all of them with pathologic radiotracer uptake Patients characteristics: 20 male, 13 female, mean age 59 years old PET/CT indication: 30 oncologic patients-head and neck (5), breast (4), lung (5), lymphoma (3), multiple myeloma (1), colorectal (3), sarcoma (1), unknown primary tumor (1), endometrium (1), melanoma (1), prostate (3), SPN (1), thyroid (1)-and 3 patients with fever of unknown origin Based on PET/CT findings, PCR was performed in 22/33 (66 6%) patients 0-12 days after PET/CT, with 12 positive and 10 negative results All patients with positive PCR received specific treatment and isolation measures, and two of them had surgery delayed From the 10 patients with negative PCR results, three of them were symptomatic a few weeks before;1 patient had Klebsiella pneumonie present in BAS;6 patients don't have more clinical data 11 patients had no PCR done;1 of them was found to be clinically suspicious, and was prescribed to start specific treatment, isolation, and surgery was delayed;the rest don't have further clinical follow up Conclusion: In the actual pandemic state, incidental PET/ CT lung findings are useful to identify COVID-19 associated pneumonia, and can change patient's medical and social management