Cervical lymphadenopathy following coronavirus disease 2019 vaccine: clinical characteristics and implications for head and neck cancer services

Abstract

Objective Patients with coronavirus disease vaccine associated lymphadenopathy are increasingly being referred to healthcare services. This work is the first to report on the incidence, clinical course and imaging features of coronavirus disease vaccine associated cervical lymphadenopathy, with special emphasis on the implications for head and neck cancer services. Methods This was a retrospective cohort study of all patients referred to our head and neck cancer clinics between 16 December 2020 and 12 March 2021. The main outcomes measured were the proportion of patients with vaccine-associated cervical lymphadenopathy, and the clinical and imaging characteristics. Results The incidence of vaccine-associated cervical lymphadenopathy referrals was 14.8 per cent (n = 13). Five patients (38.5 per cent) had abnormal-looking enlarged and rounded nodes with increased vascularity. Only seven patients (53.9 per cent) reported full resolution within an average of 3.1 ± 2.3 weeks. Conclusion Coronavirus disease vaccine associated cervical lymphadenopathy can mimic malignant lymphadenopathy and therefore might prove challenging to diagnose and manage correctly. Healthcare services may encounter a significant increase in referrals.

Rapid progression of marginal zone B-cell lymphoma after COVID-19 vaccination (BNT162b2): A case report

“…Imaging and clinical features characteristic of malignancy that are useful in differential diagnosis include >11 enlarged lymph nodes, lymph nodes with short-axis diameters >15 mm, lymphadenopathy on the contralateral side of the vaccination site, and/or lymphadenopathy in a region other than the axial and supraclavicular regions. Cervical lymphadenopathy after administration of mRNA COVID-19 vaccines is not rare, with a reported prevalence of 9% on CT ( 16 ) and 5 and 14.8% on US ( 17 , 18 ). The number of cervical lymphadenopathies ranged from 1 to 10 on CT ( 16 ) and 1–5 on US ( 19 ).…”

“…The number of cervical lymphadenopathies ranged from 1 to 10 on CT ( 16 ) and 1–5 on US ( 19 ). The median short-axis diameter of the largest node in the cervical lymphadenopathy was 7 mm (range, 5–14 mm) on CT ( 16 ) and 5.2 mm (range, 3.4–8.2 mm) on US ( 18 ). mRNA COVID-19 vaccine-related lymphadenopathy was mostly identified on the injected side ( 1 , 2 ) and in the axial and/or supraclavicular regions ( 20 , 21 ).…”

“…Of these findings, the mass in our case showed eccentric cortical thickness. However, many mRNA COVID-19 vaccine-related lymphadenopathies show asymmetric eccentric cortical thickening, loss of an echogenic hilum, and increased vascularity on US ( 18 , 19 ). Therefore, other than the irregular margin, mRNA COVID-19 vaccine-related lymphadenopathies can be indistinguishable from neoplastic lymphadenopathies.…”

“…Recommendations by the Canadian Society of Breast Imaging, Society of Breast Imaging, and European Society of Breast Imaging for the treatment of lymphadenopathy after the administration of mRNA COVID-19 vaccines advise waiting and monitoring for over 4–6 weeks ( 6 , 8 , 9 ). However, opinions differ on whether a long-term observation is acceptable for distinguishing benign from neoplastic lymphadenopathy because lymph node swelling after the administration of mRNA COVID-19 vaccines has been reported to persist for over 4 weeks in 50% ( 18 ) and 20% ( 26 ) of patients on US. In particular, lymphadenopathy in an atypical region (such as the upper cervical region), involvement of multiple lymph nodes, and extraordinary enlargement of lymph nodes may need to be observed for a shorter duration of ~4 weeks before treatment, as recommended by the three societies ( 6 , 8 , 9 ).…”

Thank you to our reviewers and editorial team

“…Our 'best paper' prizes are judged by Liam Flood, Iain Swan, Desmond Nunez and Patrick Bradley. We congratulate the winner and two runners up [1][2][3] for their high-quality work. We thank the judges for the considerable time spent on this onerous task, which helps to encourage our authors who dedicate much time and energy on producing their papers.…”