Multidisciplinary Recommendations Regarding Post-Vaccine Adenopathy                     and Radiologic Imaging: <i>Radiology</i> Scientific Expert                     Panel

Becker, Anton S.; Pérez-Johnston, Rocío; Chikarmane, Sona A.; Chen, Melissa; Homsi, Maria El; Feigin, Kimberly N.; Gallagher, Katherine; Hanna, Ehab Y.; Hicks, Marshall E.; Ilıca, Ahmet Turan; Mayer, Erica L.; Shinagare, Atul B.; Yeh, Randy; Mayerhoefer, Marius E.; Hricak, Hedvig; Vargas, Hebert Alberto

doi:10.1148/radiol.2021210436

Cited by 137 publications

(208 citation statements)

References 14 publications

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“…9,10 Lymphadenopathy detected clinically or in routine surveillance scans might create a diagnostic and management dilemma for oncology patients. 10,21 Not only that CVALs could exhibit abnormal features on ultrasound scans, but they are also shown to be metabolically active on positron emission tomographic (PET) images, with intensities similar to malignant lymphadenopathy. [8][9][10]21 A recent study by Cohen et al on PET-positive supraclavicular and axillary lymphadenopathy in 728 oncology patients, following the Pfizer/BioNTech vaccine, the incidence of overall and supraclavicular CVAL was 36.5% and 8% respectively, with supraclavicular CVAL being more commonly encountered after the second dose (9.1%) compared to the first dose (5.5%).…”

Section: Uss Features Of Covid-19 Vaccine-associated Lymphadenopathymentioning

confidence: 99%

“…10,21 Not only that CVALs could exhibit abnormal features on ultrasound scans, but they are also shown to be metabolically active on positron emission tomographic (PET) images, with intensities similar to malignant lymphadenopathy. [8][9][10]21 A recent study by Cohen et al on PET-positive supraclavicular and axillary lymphadenopathy in 728 oncology patients, following the Pfizer/BioNTech vaccine, the incidence of overall and supraclavicular CVAL was 36.5% and 8% respectively, with supraclavicular CVAL being more commonly encountered after the second dose (9.1%) compared to the first dose (5.5%). 21 Recommendations for appropriate management of CVAL should aim to strike a balance between avoiding delayed cancer diagnoses, and minimizing patient harm by invasive biopsies, unnecessary scans, and heightened anxiety.…”

Section: Uss Features Of Covid-19 Vaccine-associated Lymphadenopathymentioning

confidence: 99%

“…3,[5][6][7] With the widespread rollout of COVID-19 vaccination programmes, lymphadenopathy have created a diagnostic and therapeutic dilemma for cancer screening and diagnosis services. [8][9][10] For this reason, the United States Society of Breast Imaging, the Canadian Society of Breast Imaging, the Canadian Association of Radiologists, and a multidisciplinary team (MDT) of experts from three leading cancer centres in the United States have all recently released emergency recommendations for the management of COVID-19 vaccine-associated lymphadenopathy (CVAL). 7, 10,11 Cases of ipsilateral lymphadenopathy in the lower neck and supraclavicular region following COVID-19 vaccinations are quickly emerging in the international literature, and certainly being increasingly referred to the healthcare services for advice and management.…”

Section: Introductionmentioning

confidence: 99%

“…[8][9][10] For this reason, the United States Society of Breast Imaging, the Canadian Society of Breast Imaging, the Canadian Association of Radiologists, and a multidisciplinary team (MDT) of experts from three leading cancer centres in the United States have all recently released emergency recommendations for the management of COVID-19 vaccine-associated lymphadenopathy (CVAL). 7, 10,11 Cases of ipsilateral lymphadenopathy in the lower neck and supraclavicular region following COVID-19 vaccinations are quickly emerging in the international literature, and certainly being increasingly referred to the healthcare services for advice and management. [12][13][14] As lower neck lymphadenopathy usually harbours malignancy in around 75% of cases, the UK National Institute for Health and Care Excellence (NICE) recommended fast-track referral of unexplained or persistent cases through a dedicated pathway for suspected H&N cancer.…”

Section: Introductionmentioning

confidence: 99%

“…15,16 The differential diagnosis of lymphadenopathy in the lower neck is broad, but it is imperative to exclude pathologies like head and neck (H&N) malignancy, lymphoma, and metastatic lung or cutaneous cancers. 10,15 However, as vaccine deployment is still in its early stages, no data is yet available regarding the presentation, clinical course, or imaging characteristics of cervical COVID-19 vaccine-associated lymphadenopathy (CVAL) to guide the decision-making process in such patients. The presented work is the first study to report on the characteristics and clinical course of cervical lymphadenopathy following COVID-19 vaccination, with special emphasis on potential implications for the head and neck cancer services.…”

Section: Introductionmentioning

confidence: 99%

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

Abou‐Foul

Ross

Abou-Foul

et al. 2021

Preprint

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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.

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Section: Uss Features Of Covid-19 Vaccine-associated Lymphadenopathymentioning

confidence: 99%

Section: Uss Features Of Covid-19 Vaccine-associated Lymphadenopathymentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

See 3 more Smart Citations

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

Abou‐Foul

Ross

Abou-Foul

et al. 2021

Preprint

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Axillary Lymphadenopathy After COVID-19 Vaccination in a Woman With Breast Cancer

Lam

Flanagan

2022

JAMA

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A 39-year-old healthy woman without family history of malignancy found a mass in her right breast at 38 weeks of pregnancy. Prior to delivery, she underwent diagnostic ultrasound of the right breast, which showed a possible mass in the location of the palpable lesion that was most consistent with a normal island of fibroglandular tissue. Follow-up mammogram and ultrasound of the right breast (without axillary evaluation) were performed 6 months later, which showed anirregular17-mmmasswithassociatedpleomorphiccalcificationsinthesamearea.Ultrasoundguided biopsy was performed. Pathology showed high-grade, estrogen receptor-positive ductalcarcinomainsitu(DCIS).Onpostbiopsyphysicalexamination,thepatienthadapalpable2.5-cm right breast mass at the 3-o'clock position without palpable axillary lymphadenopathy.Surgical treatment with lumpectomy was recommended, and breast magnetic resonance imaging (MRI) was performed prior to surgery to evaluate the extent of disease (Figure). Axial T2-weighted MRI at the level of the axilla revealed edema surrounding 2 enlarged, morphologically abnormal right level-1 axillary lymph nodes; axial postcontrast T1 fat-saturated MRI of the right breast revealed an irregular mass with irregular margins at the site of biopsy-proven DCIS. The patient reported receiving her second dose of COVID-19 vaccine (Pfizer-BioNTech) in the right arm the day before the breast MRI. Diagnosis Vaccination-associated reactive lymphadenopathyWhat to Do Next D. Perform right axillary ultrasound now, with intent to biopsy enlarged lymph nodes

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Frequency and Outcomes of Ipsilateral Axillary Lymphadenopathy After COVID-19 Vaccination

2022

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Multidisciplinary Recommendations Regarding Post-Vaccine Adenopathy and Radiologic Imaging: Radiology Scientific Expert Panel

Cited by 137 publications

References 14 publications

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

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

Axillary Lymphadenopathy After COVID-19 Vaccination in a Woman With Breast Cancer

Frequency and Outcomes of Ipsilateral Axillary Lymphadenopathy After COVID-19 Vaccination

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