The location of unilateral axillary lymphadenopathy after COVID-19 vaccination compared with that of metastasis from breast cancer without vaccination

Abstract

Purpose Unilateral axillary lymphadenopathy is known to occur after coronavirus disease (COVID-19) vaccination. Post-vaccination lymphadenopathy may mimic the metastatic lymph nodes in breast cancer, and it is challenging to distinguish between them. This study investigated whether the localization of axillary lymphadenopathy on magnetic resonance imaging (MRI) could be used to distinguish reactive lymphadenopathy after COVID-19 vaccines from metastatic nodes. Materials and methods We retrospectively examined preoperative MRI images of 684 axillae in 342 patients who underwent breast cancer surgery from June to October 2021. Lymphadenopathy was defined as cortical thickening or short axis ≥ 5 mm. The axilla was divided into ventral and dorsal parts on the axial plane using a perpendicular line extending from the most anterior margin of the muscle group, including the deltoid, latissimus dorsi, or teres major muscles, relative to a line along the lateral chest wall. We recorded the presence or absence of axillary lymphadenopathy in each area and the number of visible lymph nodes. Results Of 80 axillae, 41 and 39 were included in the vaccine and metastasis groups, respectively. The median time from the last vaccination to MRI was 19 days in the vaccine group. The number of visible axillary lymph nodes was significantly higher in the vaccine group (median, 15 nodes) than in the metastasis group (7 nodes) (P < 0.001). Dorsal lymphadenopathy was observed in 16 (39.0%) and two (5.1%) axillae in the vaccine and metastasis groups, respectively (P < 0.001). If the presence of both ventral and dorsal lymphadenopathy is considered indicative of vaccine-induced reaction, this finding has a sensitivity of 34.1%, specificity of 97.4%, and positive and negative predictive values of 93.3％ and 58.5%, respectively. Conclusion The presence of deep axillary lymphadenopathy may be an important factor for distinguishing post-vaccination lymphadenopathy from metastasis. The number of axillary lymph nodes may also help.

Examination of iatrogenic FDG accumulation after COVID-19 vaccination

“…Although it is di cult to discriminate between benign and malignant accumulation levels, Eifer et al reported that machine learning using the characteristic features of PET, CT, and PET/CT images could discriminate between reactive lymph nodes caused by COVID-19 vaccination and metastatic lymph nodes caused by breast cancer with a high rate of accuracy(13). Mukai et al reported that both ventral and dorsal lymphadenopathies are more likely to be vaccine-induced reactions than metastases(29). This may help distinguish post-vaccination lymphadenopathy from metastasis.…”

Long-Term Immunological Alertness and Response to COVID-19 Vaccination—Conditions for Prevention in Early Palliative Oncological Care Patients

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Vaccination of Adults With Cancer: ASCO Guideline

“…After applying the eligibility criteria, 102 studies remained, forming the evidentiary basis for the guideline recommendations: 24 systematic reviews, 11, 14 RCTs, 6,[44][45][46][47][48][49][50][51][52][53][54][55][56] and 64 nonrandomized studies. [85][86][87][88][89][90][91][92][93][94][95][96][97][98][99][100][101][102][103][104][105][106][107][108][109][110][111][112][113][114][115][116][117][118][119][120] The ...…”