Korean Journal of Radiology

The Korean Society of Radiology (대한영상의학회)
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COVID-19 Vaccine-Related Axillary and Cervical Lymphadenopathy in Patients with Current or Prior Breast Cancer and Other Malignancies: Cross-Sectional Imaging Findings on MRI, CT, and PET-CT

  • Deanna L Lane (Department of Breast Imaging, The University of Texas MD Anderson Cancer Center) ;
  • Sattva S Neelapu (Department of Lymphoma/Myeloma, The University of Texas MD Anderson Cancer Center) ;
  • Guofan Xu (Department of Nuclear Medicine, The University of Texas MD Anderson Cancer Center) ;
  • Olena Weaver (Department of Breast Imaging, The University of Texas MD Anderson Cancer Center)
  • Received : 2021.04.24
  • Accepted : 2021.09.15
  • Published : 2021.12.01
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Abstract

Breast radiologists are increasingly seeing patients with axillary adenopathy related to COVID-19 vaccination. Vaccination can cause levels I-III axillary as well as cervical lymphadenopathy. Appropriate management of vaccine-related adenopathy may vary depending on clinical context. In patients with current or past history of malignancy, vaccine-related adenopathy can be indistinguishable from nodal metastasis. This article presents imaging findings of oncology patients with adenopathy seen in the axilla or neck on cross-sectional imaging (breast MRI, CT, or PET-CT) after COVID-19 vaccination. Management approach and rationale is discussed, along with consideration on strategies to minimize false positives in vaccinated cancer patients. Time interval between vaccination and adenopathy seen on breast MRI, CT, or PET-CT is also reported.

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References

  1. US Food & Drug Adminstration. FDA takes key action in fight against COVID-19 by issuing emergency use authorization for first COVID-19 vaccine. FDA.gov Web site. https://www.fda. gov/news-events/press-announcements/fda-takes-key-action-fight-against-covid-19-issuing-emergency-use-authorization-first-covid-19. Accessed February 10, 2021
  2. Centers for Disease Control and Prevention. The moderna COVID-19 vaccine's local reactions, systemic reactions, adverse events, and serious adverse events. CDC.gov Web site. https://www.cdc.gov/vaccines/covid-19/info-by-product/moderna/reactogenicity.html. Accessed February 10, 2021
  3. Centers for Disease Control and Prevention. Local reactions, systemic reactions, adverse events, and serious adverse events: Pfizer-BioNTech COVID-19 vaccine. CDC.gov Web site. https://www.cdc.gov/vaccines/covid-19/info-by-product/ pfizer/reactogenicity.html. Accessed February 10, 2021
  4. Becker AS, Perez-Johnston R, Chikarmane SA, Chen MM, El Homsi M, Feigin KN, et al. Multidisciplinary recommendations regarding post-vaccine adenopathy and radiologic imaging: radiology scientific expert panel. Radiology 2021;300:E323-E327 
  5. Lehman CD, D'Alessandro HA, Mendoza DP, Succi MD, Kambadakone A, Lamb LR. Unilateral lymphadenopathy after COVID-19 vaccination: a practical management plan for radiologists across specialties. J Am Coll Radiol 2021;18:843-852 
  6. Grimm L, Destounis S, Dogan B, Nicholson B, Dontchos B, Sonnenblick E, et al. SBI recommendations for the management of axillary adenopathy in patients with recent COVID-19 vaccination. SBI-online.org Web site. https://www.sbi-online.org/Portals/0/Position%20Statements/2021/SBI-recommendations-for-managing-axillary-adenopathy-post-COVID-vaccination.pdf. Accessed February 10, 2021
  7. Freer PE. The impact of the COVID-19 pandemic on breast imaging. Radiol Clin North Am 2021;59:1-11 
  8. Lehman CD, Lamb LR, D'Alessandro HA. Mitigating the impact of coronavirus disease (COVID-19) vaccinations on patients undergoing breast imaging examinations: a pragmatic approach. AJR Am J Roentgenol 2021;217:584-586 
  9. Herrera-Martinez Y, Acevedo-Banez I, De-Bonilla-Damia A, Fernandez-Rodriguez P, Sousa JM, Jimenez-Hoyuela Garcia JM. Contralateral axillary lymph node metastasis in a patient with relapsed breast cancer: locoregional event or distant metastasis disease? Oncol Res Treat 2021;44:128-131 
  10. Zhang Z, Zhang Y, Sun X. Therapeutic options for contralateral axillary lymph node metastasis in breast cancer. Curr Probl Cancer 2021 Jan [Epub]. https://doi.org/10.1016/j.currproblcancer.2020.100706 
  11. Katal S, Pouraryan A, Gholamrezanezhad A. COVID-19 vaccine is here: practical considerations for clinical imaging applications. Clin Imaging 2021;76:38-41 
  12. Eifer M, Eshet Y. Imaging of COVID-19 vaccination at FDG PET/CT. Radiology 2021;299:E248 
  13. Xu G, Lu Y. COVID-19 mRNA vaccination-induced lymphadenopathy mimics lymphoma progression on FDG PET/CT. Clin Nucl Med 2021;46:353-354 
  14. Orevi M, Chicheportiche A, Ben-Haim S. Lessons learned from post-COVID-19 vaccination PET/CT studies. J Nucl Med 2021 Jul [Epub]. https://doi.org/10.2967/jnumed.121.262348 
  15. Skawran S, Gennari AG, Dittli M, Treyer V, Muehlematter UJ, Maurer A, et al. [18F]FDG uptake of axillary lymph nodes after COVID-19 vaccination in oncological PET/CT: frequency, intensity, and potential clinical impact. Eur Radiol 2021 Jun [Epub]. https://doi.org/10.1007/s00330-021-08122-2 
  16. Shirone N, Shinkai T, Yamane T, Uto F, Yoshimura H, Tamai H, et al. Axillary lymph node accumulation on FDG-PET/CT after influenza vaccination. Ann Nucl Med 2012;26:248-252 
  17. Burger IA, Husmann L, Hany TF, Schmid DT, Schaefer NG. Incidence and intensity of F-18 FDG uptake after vaccination with H1N1 vaccine. Clin Nucl Med 2011;36:848-853 
  18. McIntosh LJ, Bankier AA, Vijayaraghavan GR, Licho R, Rosen MP. COVID-19 vaccination-related uptake on FDG PET/CT: an emerging dilemma and suggestions for management. AJR Am J Roentgenol 2021;217:975-983 
  19. Eshet Y, Tau N, Alhoubani Y, Kanana N, Domachevsky L, Eifer M. Prevalence of increased FDG PET/CT axillary lymph node uptake beyond 6 weeks after mRNA COVID-19 vaccination. Radiology 2021;300:E345-E347 
  20. Edmonds CE, Zuckerman SP, Conant EF. Management of unilateral axillary lymphadenopathy detected on breast MRI in the era of coronavirus disease (COVID-19) vaccination. AJR Am J Roentgenol 2021;217:831-834 
  21. Plaza MJ, Wright J, Fernandez S. COVID-19 vaccine-related unilateral axillary lymphadenopathy: pattern on screening breast MRI allowing for a benign assessment. Clin Imaging 2021;80:139-141