Regional lymphadenopathy following COVID-19 vaccination: Literature review and considerations for patient management in breast cancer care

Abstract

Purpose Over 1 billion doses of COVID-19 vaccines have been already administered across the US, the UK and the EU at the time of writing. Furthermore, 1.82 million of booster doses have been administered in the US since 13 th August, and similar booster programmes are currently planned or under consideration in the UK and the EU beginning in the autumn of 2021. Early reports showed an association between vaccine administration and the development of ipsilateral axillary and supraclavicular lymphadenopathy which could interfere with the diagnosis, treatment and follow-up of breast cancer patients. In this paper, we review the available evidence on vaccine-related lymphadenopathy, and we discuss the clinical implications of same on breast cancer diagnosis and management. Methods A literature search was performed - PubMed, Ovid Medline, Scopus, CINHAL, Springer Nature, Sciencedirect, Academic Search Premiere and the Directory of Open Access Journals were searched for articles reporting on regional palpable or image-detected lymphadenopathy following COVID-19 vaccination. Separately, we compiled a series of case studies from the University Hospitals of Derby and Burton, UK and the Mayo Clinic in Minnesota, USA to illustrate the impact that regional lymphadenopathy post-COVID-19 vaccination can have on the diagnosis and management of patients being seen in diagnostic and therapeutic breast clinics. Results From the literature search 15 studies met the inclusion criteria (n = 2057 patients, 737 with lymphadenopathy). The incidence of lymphadenopathy ranged between 14.5% and 53% and persisted for >6 weeks in 29% of patients. Conclusions Clinicians managing breast cancer patients should be aware that the COVID-19 vaccination may result in regional lymphadenopathy in a significant number of patients which can result in unnecessary investigations, treatment and increased patient anxiety. An accurate COVID-19 vaccination history should be collected from all patients where regional lymphadenopathy is a clinical &/or an imaging finding and then combined with clinical judgment when managing individual cases.

COVID-19 vaccines in patients with cancer: immunogenicity, efficacy and safety

“…A literature review of data from 15 studies involving >2,000 patients with breast cancer showed that the incidence of vaccine-induced lymphadenopathy ranges from 14.5% to 53%. This lymphadenopathy persisted for >6 weeks in 29% of patients 153 . Radiation recall phenomena, such as pneumonitis or dermatitis, have been described following COVID-19 vaccination [157][158][159] .…”

“…Local lymphadenopathy commonly occurs after COVID-19 vaccination. Vaccine-induced lymphadenopathy found on CT or PET could be mistaken for lymph node metastases in certain patients, such as those with breast cancer or melanoma [153][154][155][156] , although unlike cancer, the lymph node enlargement usually completely resolves spontaneously 139 . A literature review of data from 15 studies involving >2,000 patients with breast cancer showed that the incidence of vaccine-induced lymphadenopathy ranges from 14.5% to 53%.…”

Letter to the Editor: The possible role of lymphadenopathy after vaccination in posttraumatic stress disorder in cancer survivors during COVID-19

“…Additionally, as the COVID-19 vaccines gradually released to the public in the first year of the pandemic, the vaccination coverage (at least one shot) had been administered to approximately 60% of the eligible population worldwide. [5] Cases of lymph nodes enlargement after vaccination for weeks to months, especially axillary and supraclavicular lymphadenopathy had been noticed [6,7]. Most of the cases of lymphadenopathy were discovered by regular follow-up imaging studies [8].…”

“…Findings from mammography, sonography over neck or breast, computed tomography, or magnetic resonance imaging were all possible. There was a broad consensus that the COVID-19 vaccination should not be postponed even considering the worry of cancer survivor follow-up imaging [6]. However, recommendations varied by countries.…”

“…However, recommendations varied by countries. The Society of Breast Imaging in the USA had altered the suggestions either receiving imaging before the first dose or 6 to 10 weeks after vaccination, whereas no specific recommendations had been proposed in Europe or UK [6]. Managements in response to the lymphadenopathy and suspicious malignancy including shortening interval of imaging followup or even confirming diagnosis by biopsy, depending on the pathological pattern might still have chance to be arranged.…”