Axillary Lymphadenopathy on Ultrasound after COVID-19 Vaccination and Its Influencing Factors: A Single-Center Study

Abstract

Purpose: This study aimed to assess the incidence of axillary lymphadenopathy on ultrasound after COVID-19 vaccination and to investigate the factors affecting lymphadenopathy. Methods: We evaluated patients who had received a COVID-19 vaccination within 12 weeks before an ultrasound examination between August and October 2021. The incidence of vaccine-related ipsilateral axillary lymphadenopathy was evaluated using ultrasound. Age, sex, presence of axillary symptoms, injection site, vaccine type, interval from vaccination, and dose were compared between the groups with and without axillary lymphadenopathy. Results: We included 413 patients, 202 (49%) of whom showed axillary lymphadenopathy on ultrasound after COVID-19 vaccination. Age, interval from vaccine, vaccine brand, vaccine type, dose, and symptom were significantly different between the lymphadenopathy and non-lymphadenopathy groups (p < 0.001), while the injection site and sex were not. Receiving an mRNA vaccine was the most important factor for axillary lymphadenopathy (p < 0.001), followed by intervals of 1–14 (p < 0.001) and 15–28 days (p < 0.001), younger age (p = 0.006), and first dose (p = 0.045). Conclusion: COVID-19 vaccine-related axillary lymphadenopathy on ultrasound is common. mRNA type, an interval of 4 weeks, younger age, and first dose were the important factors. Breast clinicians should be well aware of these side effects when performing imaging examinations and provide accurate information to patients.

The Safety of mRNA-1273, BNT162b2 and JNJ-78436735 COVID-19 Vaccines: Safety Monitoring for Adverse Events Using Real-World Data

“…On the other hand, some AEs, including Bell's palsy, myocarditis/pericarditis, convulsions/seizures, lymphadenopathy, and anaphylaxis, exhibited a high incidence in young people. In the previous studies, lymphadenopathy [12] and myocarditis/pericarditis [13] have been reported with a higher frequency in the younger population. This study also showed more frequency of inflammation-related AEs such as Bell's palsy, myocarditis/pericarditis, lymphadenopathy, which seemed to estimate high in young people.…”

Axillary lymph node characteristics in breast cancer patients versus post-COVID-19 vaccination: Overview of current evidence per imaging modality

“…Unfortunately, the true number of false positive characteristics due to post-COVID-19 vaccination remains unclear because no tissue sampling was performed. In addition, they reported significantly more frequent lymphadenopathy post-COVID-19 vaccination after mRNA vaccine (Comirnaty, Spikevax) when compared to a vector vaccine (Vaxzevria) [17] . On the other hand, in a cohort of 24 patients with lymphadenopathy at physical examination, Cocco et al found no differences in the frequency of lymphadenopathy among different COVID-19 vaccines (Comirnaty, Vaxzevria and Spikevax, respectively) detected at US [18] .…”

“…Interestingly, a significantly greater cortical thickness was observed in patients without a previous history of COVID-19 pneumonia. Park et al demonstrated lymphadenopathy post-COVID-19 vaccination in 49% of the healthy women referred to a breast cancer unit within 12 weeks after vaccination in a cohort of 413 women [17] . Unfortunately, the true number of false positive characteristics due to post-COVID-19 vaccination remains unclear because no tissue sampling was performed.…”

Regional Lymphadenopathy Following COVID-19 Vaccination in Patients with or Suspicious of Breast Cancer: A Quick Summary of Current Key Facts and Recommendations

“…In asymptomatic healthy women without risk of metastatic lymphadenopathy, imaging–detected unilateral axillary lymphadenopathy on the same side of the recent COVID-19 vaccination (i.e., within 12 weeks) should be classified as a benign finding, and no further workup should be recommended [ 11 ]. According to published articles on COVID-19 vaccine-associated lymphadenopathies, the most frequently observed morphological characteristics include enlarged lymph nodes with uniform cortical thickening > 3 mm and increased numbers of enlarged lymph nodes [ 12 13 ]. It is more commonly observed within a time interval of 4 weeks after receiving COVID-19 mRNA vaccines than after receiving vector vaccines [ 13 ].…”