Unilateral axillary Adenopathy in the setting of COVID-19 vaccine

Mehta, Neelesh B.; Sales, Rachel Marcus; Babagbemi, Kemi; Levy, Allison; McGrath, Anika L.; Drotman, Michele; Dodelzon, Katerina

doi:10.1016/j.clinimag.2021.01.016

Cited by 137 publications

(155 citation statements)

References 7 publications

Supporting

Mentioning

145

Contrasting

Unclassified

Order By: Relevance

“…Previously vaccine associated lymphadenopathy was anecdotally reported. Mehta et al described 3 cases of patients coming for routine screening mammography and ultrasound, and one patient presented due to palpable lump in the ipsilateral vaccinated arm [4] . Eifer and Eshet reported a patient who underwent lumpectomy for breast cancer in whom contralateral lymphadenopathy and FDG uptake were attributed to reactive post vaccination lymphadenopathy [5] .…”

Section: Discussionmentioning

confidence: 99%

“…Yet these vaccination campaigns have never been so massive and deployed on a nation-wide basis as the current SARS -CoV-2 vaccine campaign in Israel. Recently, several case reports on the occurrence of post-COVID 19 vaccination axillary lymphadenopathy were published 4 , 5 , 6 , 7 , 8 . In February 2021, a scientific expert panel published recommendations regarding post vaccination lymphadenopathy for patients undergoing imaging that includes the axillae [ 9 , 10 ].…”

Section: Introductionmentioning

confidence: 99%

See 1 more Smart Citation

COVID-19 Vaccination Induced Lymphadenopathy in a Specialized Breast Imaging Clinic in Israel: Analysis of 163 cases

et al. 2021

View full text Add to dashboard Cite

Introduction: Following vaccination of Israeli population with Pfizer-BioNTech COVID-19 Vaccine, an unusual increase in axillary-lymphadenopathy was noted. This study assesses the rate and magnitude of this trend from breast-imaging standpoint. Materials and Methods: Participants undergoing breast-imaging, in whom isolated axillary-lymphadenopathy was detected were questioned regarding SARS-CoV-2 vaccine to the ipsilateral arm. Patients’ and imaging characteristics were statistically compared. In order to perform a very short-term follow-up, twelve healthy vaccinated medical staff-members, underwent axillary-ultrasound shortly after the second dose, and follow-up. Results: Axillary-lymphadenopathy attributed to vaccination was found in 163 women undergoing breast-imaging, including BRCA -carriers. During the study, number of detected lymphadenopathies increased by 394% (p=0.00001) in comparison with previous two consecutive years. Mean cortical-thickness of abnormal lymph-nodes after second dose vaccination was 5±2 mm. Longer lymph-node diameter after second vaccination was noted (from 15±5 mm, to 18±6 mm, p=0.005). In the subgroup of medical staff members, following trends were observed: in patients with positive antibodies, lymph-node cortical-thickness was larger than patients with negative serology (p=0.03); lymph-node cortical-thickness decreased in 4-5 weeks follow-up (p=0.007). Lymphadenopathy was evident on mammography in only 49% of cases. Discussion: Vaccine-associated lymphadenopathy is an important phenomenon with great impact on breast-imaging clinic workload. Results suggest the appearance of cortical thickening shortly after both doses. Positive serology is associated with increased lymph-node cortical-thickness. In asymptomatic vaccinated women with ipsilateral axillary-lymphadenopathy as the only abnormal finding, radiological follow-up is probably not indicated. BRCA -carriers, although at higher risk for breast-cancer, should probably receive the same management as average-risk patients.

show abstract

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

COVID-19 Vaccination Induced Lymphadenopathy in a Specialized Breast Imaging Clinic in Israel: Analysis of 163 cases

et al. 2021

View full text Add to dashboard Cite

show abstract

“…Several case reports and small cohort studies have already highlighted the medical imaging identification of vaccineassociated lymphadenopathy post-anti-SARS-CoV-2 vaccines [6][7][8][9][10][11][12][13][14][15][16][17][18]. Specifically, a very recent special report published by Radiology scientific expert panel explores the concern of accurate imaging report in view of lymphadenopathy associated with vaccination, although, as the authors state, the proportion of patients experiencing some form of lymphadenopathy is not available.…”

Section: Introductionmentioning

confidence: 99%

Hypermetabolic lymphadenopathy following administration of BNT162b2 mRNA Covid-19 vaccine: incidence assessed by [18F]FDG PET-CT and relevance to study interpretation

Cohen

Krauthammer

Wolf

et al. 2021

Eur J Nucl Med Mol Imaging

114

177

View full text Add to dashboard Cite

Purpose Nationwide mass vaccination against Covid-19 started in Israel in late 2020. Soon we identified on [18F]FDG PET-CT studies vaccine-associated hypermetabolic lymphadenopathy (VAHL) in axillary or supraclavicular lymph nodes (ASLN) ipsilateral to the vaccination site. Sometimes, differentiation between the malignant and benign nature of the hypermetabolic lymphadenopathy (HLN) could not be made, and equivocal HLN (EqHL) was reported. The purpose of the study was to determine the overall incidence of VAHL after BNT162b2 vaccination and also its relevance to PET-CT interpretation in oncologic patients. Methods A total of 951 consecutive patients that underwent [18F]FDG PET-CT studies in our department were interviewed regarding the sites and dates of the vaccine doses. A total of 728 vaccinated patients (All-Vac group) were included: 346 received the first dose only (Vac-1 group) and 382 received the booster dose as well (Vac-2 group). Studies were categorized as no HLN, malignant-HLN (MHL), VAHL, or EqHL. In studies with VAHL, location, [18F]FDG-intensity uptake and nodes size were recorded. Results The incidences of HLN were 45.6%, 36.4%, and 53.9% in All-Vac, Vac-1, and Vac-2 groups, respectively. VAHL was reported in 80.1% of vaccinated patients with HLN. Lower incidences of VAHL were found during the first 5 days or in the third week after the first vaccine and beyond 20 days after the booster dose. In 49 of 332 (14.8%) vaccinated patients, we could not determine whether HLN was MHL or VAHL. Breast cancer and lymphoma were the leading diseases with EqHL. Conclusion VAHL is frequently observed after BNT162b2 administration, more commonly and with higher intensity following the booster dose. To minimize false and equivocal reports in oncological patients, timing of [18F]FDG PET-CT should be based on the time intervals found to have a lower incidence of VAHL, and choice of vaccine injection site should be advised, mainly in patients where ASLN are a relevant site of tumor involvement.

show abstract

“…Since March 2021, there have been multiple articles discussing ipsilateral axillary adenopathy following COVID-19 vaccination (specifically the mRNA vaccines), including a case series from an institution in New York reporting 4 cases of unilateral axillary lymphadenopathy following COVID-19 vaccination in the ipsilateral arm, although no interval follow-up had been reported at time of publication. 7 There have also been reports on multiple online physician and breast radiology forums, including the Society for Breast Imaging and the American College of Radiology, of either personal experiences or seeing an increased number of imaging cases of ipsilateral axillary adenopathy following COVID-19 vaccination.…”

Section: Introductionmentioning

confidence: 99%

Axillary adenopathy following COVID-19 vaccination: A single institution case series

2021

View full text Add to dashboard Cite

Axillary adenopathy is a potential side effect following COVID-19 vaccination. We report four cases of axillary adenopathy in the setting of recent COVID-19 vaccination (Moderna and Pfizer-BioNTech) at our institution. Our cases show unilateral axillary adenopathy, as well as adenopathy persisting for two to three weeks following vaccination. The Society of Breast Imaging (SBI) and Harvard University have each released guidelines for management of axillary adenopathy following COVID-19 vaccination. While SBI recommends short term imaging 4–12 weeks following the second dose, a group of physicians from Harvard suggest clinical follow-up with sonographic imaging if clinical concern persists beyond six weeks. As a larger percentage of the general population becomes vaccinated, it is important for radiologists to be aware of potential vaccine-induced ipsilateral axillary adenopathy on screening and diagnostic breast imaging to reduce the number of unnecessary biopsies performed in this patient population.

show abstract

Unilateral axillary Adenopathy in the setting of COVID-19 vaccine

Cited by 137 publications

References 7 publications

COVID-19 Vaccination Induced Lymphadenopathy in a Specialized Breast Imaging Clinic in Israel: Analysis of 163 cases

COVID-19 Vaccination Induced Lymphadenopathy in a Specialized Breast Imaging Clinic in Israel: Analysis of 163 cases

Hypermetabolic lymphadenopathy following administration of BNT162b2 mRNA Covid-19 vaccine: incidence assessed by [18F]FDG PET-CT and relevance to study interpretation

Axillary adenopathy following COVID-19 vaccination: A single institution case series

Contact Info

Product

Resources

About