Management of Unilateral Axillary Lymphadenopathy Detected on Breast MRI in the Era of COVID-19 Vaccination

Edmonds, Christine E.; Zuckerman, Samantha P.; Conant, Emily F.

doi:10.2214/ajr.21.25604

Cited by 86 publications

(103 citation statements)

References 8 publications

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“…For participants in breast cancer screening trials, consideration should be given to the fact that COVID-19 vaccination can cause transient lymphadenopathy 36,37 . Therefore, if possible and if patient management will not be unjustifiably interrupted, screening examinations should be conducted either before the first dose of a COVID-19 vaccine or 4-6 weeks after the second dose, as recommended previously by other groups 36,37 .…”

Section: Timing Of Vaccinationmentioning

confidence: 99%

COVID-19 vaccine guidance for patients with cancer participating in oncology clinical trials

et al. 2021

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Emerging efficacy data have led to the emergency use authorization or approval of COVID-19 vaccines in several countries worldwide. Most trials of COVID-19 vaccines excluded patients with active malignancies, and thus data on the safety, tolerability and efficacy of the vaccines in patients with cancer are currently limited. Given the risk posed by the COVID-19 pandemic, decisions regarding the use of vaccines against COVID-19 in patients participating in trials of investigational anticancer therapies need to be addressed promptly. Patients should not have to choose between enrolling on oncology clinical trials and receiving a COVID-19 vaccine. Clinical trial sponsors, investigators and treating physicians need operational guidance on COVID-19 vaccination for patients with cancer who are currently enrolled or might seek to enrol in clinical trials. Considering the high morbidity and mortality from COVID-19 in patients with cancer, the benefits of vaccination are likely to far outweigh the risks of vaccine-related adverse events. Herein, we provide operational COVID-19 vaccine guidance for patients participating in oncology clinical trials. In our perspective, continued quality oncological care requires that patients with cancer, including those involved in trials, be prioritized for COVID-19 vaccination, which should not affect trial eligibility.

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Section: Timing Of Vaccinationmentioning

confidence: 99%

COVID-19 vaccine guidance for patients with cancer participating in oncology clinical trials

et al. 2021

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“…Figure 9 shows the approach being applied at our institution, based on past experience with routine vaccinations, preliminary experience with COVID-19 vaccination, and initial publications addressing this topic [4,15,16]. At this early stage in mass vaccination, we have not yet had the opportunity to apply our suggested approach to a large number of patients.…”

Section: Pet/ct Assessment and Further Managementmentioning

confidence: 99%

“…One side effect of the vaccine that has become apparent after its mass distribution is enlargement of axillary, supraclavicular, and cervical lymph nodes on the ipsilateral side of deltoid vaccination [1,2,3]. The implications of this phenomenon have been described primarily in the context of breast imaging [4]. However, vaccine-induced lymphadenopathy may also create challenges in FDG PET/CT interpretation by confounding disease characterization, staging, and assessment of treatment response.…”

Section: Introductionmentioning

confidence: 99%

COVID-19 Vaccination-Related Uptake on FDG PET/CT: An Emerging Dilemma and Suggestions for Management

McIntosh

Bankier

Vijayaraghavan

et al. 2021

American Journal of Roentgenology

116

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The publication of this Accepted Manuscript is provided to give early visibility to the contents of the article, which will undergo additional copyediting, typesetting, and review before it is published in its final form. During the production process, errors may be discovered that could affect the content of the Accepted Manuscript. All legal disclaimers that apply to the journal pertain. The reader is cautioned to consult the definitive version of record before relying on the contents of this document.

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“…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

118

177

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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.

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Management of Unilateral Axillary Lymphadenopathy Detected on Breast MRI in the Era of COVID-19 Vaccination

Cited by 86 publications

References 8 publications

COVID-19 vaccine guidance for patients with cancer participating in oncology clinical trials

COVID-19 vaccine guidance for patients with cancer participating in oncology clinical trials

COVID-19 Vaccination-Related Uptake on FDG PET/CT: An Emerging Dilemma and Suggestions for Management

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

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