Axillary Lymph Node Uptake on &lt;sup&gt;18&lt;/sup&gt;F-FDG PET/CT after COVID-19 Vaccination: A Direct Comparison Study with Influenza Vaccination

Otomi, Yoichi; Shinya, Takayoshi; Kasai, Hiroto; Okada, Naoko; Matsushita, Tomoki; Higashi, Kohei; Matsuzaki, Saya; Hiroshima, Yuka; Kubo, Michiko; Otsuka, Hideki; Harada, Masafumi

doi:10.4274/mirt.galenos.2022.27136

Cited by 2 publications

(1 citation statement)

References 19 publications

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“…In a cohort study in 2021, increased tracer uptake in the axillary lymph nodes was seen on PET-CT in 4 of 78 patients (5 %) after recent flu vaccination [15]. In a direct comparison study between the COVID-19 vaccine and the flu vaccine, axillary LA was significantly more common after a COVID-19 vaccine (45 %) than after the flu vaccine (19 %) [16].…”

Section: Studies On Lymphadenopathy With a Focus On The Covid-19 Vaccinementioning

confidence: 98%

Vaccine-associated axillary lymphadenopathy with a focus on COVID-19 vaccines

Wilpert,

Wenkel,

Baltzer

et al. 2024

Rofo

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Axillary lymphadenopathy (LA) after COVID-19 vaccination is now known to be a common side effect. In these cases, malignancy cannot always be excluded on the basis of morphological imaging criteria.Narrative review for decision-making regarding control and follow-up intervals for axillary LA according to currently published research. This article provides a practical overview of the management of vaccine-associated LA using image examples and a flowchart and provides recommendations for follow-up intervals. A particular focus is on patients presenting for diagnostic breast imaging. The diagnostic criteria for pathological lymph nodes (LN) are explained.Axillary LA is a common adverse effect after COVID-19 vaccination (0.3–53%). The average duration of LA is more than 100 days. LA is also known to occur after other vaccinations, such as the seasonal influenza vaccine. Systematic studies on this topic are missing. Other causes of LA after vaccination (infections, autoimmune diseases, malignancies) should be considered for the differential diagnosis. If the LA persists for more than 3 months after COVID-19 vaccination, a primarily sonographic follow-up examination is recommended after another 3 months. A minimally invasive biopsy of the LA is recommended if a clinically suspicious LN persists or progresses. In the case of histologically confirmed breast cancer, a core biopsy without a follow-up interval is recommended regardless of the vaccination, as treatment appropriate to the stage should not be influenced by follow-up intervals. For follow-up after breast cancer, the procedure depends on the duration of the LA and the woman’s individual risk of recurrence.Vaccination history should be well documented and taken into account when evaluating suspicious LN. Biopsy of abnormal, persistent, or progressive LNs is recommended. Preoperative staging of breast cancer should not be delayed by follow-up. The risk of false-positive findings is accepted, and the suspicious LNs are histologically examined in a minimally invasive procedure.

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Section: Studies On Lymphadenopathy With a Focus On The Covid-19 Vaccinementioning

confidence: 98%

Vaccine-associated axillary lymphadenopathy with a focus on COVID-19 vaccines

Wilpert,

Wenkel,

Baltzer

et al. 2024

Rofo

View full text Add to dashboard Cite

show abstract

Hypermetabolic Axillary Lymph Nodes Associated with COVID-19 Vaccination in Breast Cancer Management

Taşçı¹,

DİRİCAN>²,

Sözbilen³

et al. 2023

Mirt

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A 42-year-old female patient diagnosed with invasive ductal breast ca underwent 18 F-fluorodeoxyglucose (FDG) positron emission tomography/ computed tomography (PET/CT) scan for staging, 1.5 cm diameter hypermetabolic lesion was observed in the lower inner quadrant of the right breast that was compatible with primary tumor [maximum standardized uptake value (SUV max ): 10.5]. No pathological 18 F-FDG uptake was observed in lymph nodes whose fatty hilum was seen in the right axilla. However, in the left axilla and left deep axilla, hypermetabolic lymph nodes with a maksimum diameter of 19 mm and fatty hilum were observed (SUV max : 8.0). In a detailed CT evaluation, these lymph nodes have thicker walls than the ones in the right axilla. The patient was questioned again and coronavirus disease-2019 (COVID-19) vaccination history (with BNT162b2, COVID-19 mRNA vaccine) was determined that was administrated to the left arm 5 days ago. Tru-cut biopsy was performed from the left aksillary lymph nodes and proved to be reactive lymphoid tissue and there was no primary or metastatic tumor in these axillary lymph node tissues. The patient was given neoadjuvant chemotherapy 4.5 months after the first 18 F-FDG PET/CT, and the second was performed for the treatment response evaluation. Significant regression was determined from the findings. The patient underwent right total mastechtomy. She was being followed up with adjuvant chemotherapy and radiotherapy. In conclusion, hypermetabolic lymph nodes in the axillas should be interrogated for vaccination in patients with breast cancer. Hypermetabolic lymph nodes observed on the same side of the vaccinated arm in the 18 F-FDG PET/CT scan may be related to vaccine-induced reactive lymph node enlargement. Lymph node metastasis may be excluded, especially if there are hypermetabolic lymph nodes with preserved fatty hilum in the contralateral axilla on the same side as the vaccinated arm. Active lymph nodes reactive to the vaccine become inactive after a while.

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Axillary Lymph Node Uptake on <sup>18</sup>F-FDG PET/CT after COVID-19 Vaccination: A Direct Comparison Study with Influenza Vaccination

Cited by 2 publications

References 19 publications

Vaccine-associated axillary lymphadenopathy with a focus on COVID-19 vaccines

Vaccine-associated axillary lymphadenopathy with a focus on COVID-19 vaccines

Hypermetabolic Axillary Lymph Nodes Associated with COVID-19 Vaccination in Breast Cancer Management

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