Cervical lymphadenopathy following COVID-19 vaccine: Clinical characteristics and implications for head and neck cancer services

Abstract

Objectives: Lower neck lymphadenopathy usually harbour malignancy in around 75% of cases, and should warrant an urgent referral to the head and neck (H&N) cancer services. The presented work is the first study to report on the incidence, clinical course, and imaging features of cervical CVAL (cCVAL), with special emphasis on the implications for the H&N cancer services.Design: Retrospective cohort study.Setting: Leading UK NHS trust providing tertiary H&N cancer services.Participants: Patients referred to our H&N cancer clinics with cCVAL between 16 December 2020 and 12 March 2021 (12 weeks). We defined cCVAL as any unilateral and lower cervical lymphadenopathy, noticed within two weeks of COVID-19 vaccination in the ipsilateral deltoid muscle. Main outcome measures:The proportion of patients referred with cCVAL. Secondary outcomes included the clinical and imaging characteristics and follow-up measures.Results: From 88 patients referred with cervical lymphadenopathy, 13 patients (14.8%) had cCVAL. Pain was only reported in six patients (46.2%), but swelling was noticed by all patients within a median of four days. The average diameter of CVALs on ultrasound scans was 5.5 ± 1.4 mm, and five patients (38.5%) had abnormally looking rounded node or increased vascularity on colour doppler. Seven patients (53.9%) reported full resolution of their lymphadenopathy within an average of 3.1 ± 2.3 weeks. Conclusion:Reactive cervical CVAL can mimic malignant lymphadenopathy, and therefore might prove challenging to correctly diagnose and manage. Over the next few months, primary care and H&N cancer services should be prepared for a potentially significant increase in referrals.

Firm Innovation, Managerial Ability, Size and Leverage: Impact on Firm Performance

“…Firm innovation (INOV), managerial ability (MAN), company size (SIZE), and leverage level (LEV) were chosen to measure the independent variables in this study. According to [6], experts argued that spending on research and development impacts firm performance [26]. They found that companies that invested more in research and development exhibited greater dynamic efficiency and flexibility, resulting in improved performance.…”

“…The third independent variable is the firm's size, which will be denoted as 'SIZE' in this study. Typically, larger companies demonstrate superior performance, particularly regarding financial arrangements [26]. Due to their ample resources, larger companies can pursue strategies that improve performance.…”

Rare adverse events following Covid-19 vaccination: A review

“…However, none of these vaccines have been administered massively as SARS-CoV-2 vaccines, and clinical experience suggests a notably higher incidence of lymphadenopathy following Covid-19 vaccines than other vaccines. Lymphadenitis and lymphadenopathy associated with Covid-19 vaccination usually occur within 4 weeks of administration and have been reported in almost all body parts, including axillary, pectoral, supraclavicular, cervical, inguinal, and even intraparotid regions 102,[110][111][112] . The axillary region seems to be the most common location for vaccine-associated lymph node enlargement.…”