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1.
Clin Nucl Med ; 47(7): 575-582, 2022 Jul 01.
Article in English | MEDLINE | ID: covidwho-1948622

ABSTRACT

PURPOSE: Vaccination against coronavirus disease 2019 (COVID-19) is currently under worldwide deployment. The consequences of this vaccination can be seen in radiology and nuclear medicine explorations with visualization of axillary lymph nodes (LNs), as observed on ultrasonography, MRI, or 18F-FDG PET/CT.We aimed to evaluate on PET/CT the incidence of vaccine-related LNs and their characteristics after COVID-19 vaccination, using several radiopharmaceuticals different from 18F-FDG. PATIENTS AND METHODS: Between February and July 2021, all consecutive patients undergoing a whole-body PET/CT for any indication using a different radiopharmaceutical from 18F-FDG were eligible for inclusion if they had received at least 1 dose of the COVID-19 vaccine. The radiopharmaceutical administered and vaccine type were recorded for each patient. The incidence of positive vaccine-related axillary and supraclavicular LNs on PET/CT was our primary finding, along with the nodes characteristics. Statistical analyses were performed for patients with prostate cancer (PCa) to determine certain interaction factors that were associated with the detection of vaccine-related LNs. RESULTS: Of the 226 patients in our cohort study, 120 patients underwent an 18F-fluorocholine PET/CT, 79 a 68Ga-PSMA-11 PET/CT, 6 an 18F-FDOPA PET/CT, and 21 a 68Ga-DOTATOC PET/CT. A total of 67.3% of patients (152/226) received BNT162b2mRNA (Pfizer-BioNTech), 26.5% (60/226) ChAdOx1-S (AstraZeneca), 4.9% (11/226) mRNA-1273 (Moderna), and 1.3% (3/226) Ad26.COV2.S (Janssen). The incidence of positive vaccine-related axillary and supraclavicular LNs was 42.5% (51/120 patients) on PET/CT using 18F-fluorocholine and 12.7% (10/79 patients) with 68Ga-PSMA-11. None of our patients undergoing 18F-FDOPA or 68Ga-DOTATOC PET/CT presented any vaccine-related lymphadenopathy. Vaccine-related LNs were statistically associated with the nature of the radiopharmaceutical (P < 10-4), with the number of vaccine doses received (P = 0.041), with a short delay between vaccination and PET/CT realization (P < 10-5), and with a higher prostate-specific antigen level for patients with PCa (P = 0.032), but not with age or vaccine type. The vaccine-related nodes appeared in 85% of the cases, in the 30 days after vaccine injection, were limited in size and uptake, and were most often limited to the axilla level 1 area. CONCLUSIONS: Detecting positive LNs after COVID-19 vaccination is not an exclusive 18F-FDG PET/CT pattern but is common on 18F-fluorocholine and possible on 68Ga-PSMA-11 PET/CT. Confronting PET/CT findings with clinical data (such as date and site of injection) seems essential in the current pandemic context, just as it does for the radiopharmaceuticals used in PCa to avoid PET/CT misinterpretation and incorrect patient treatment. For 18F-FDOPA or 68Ga-DOTATOC PET/CT, this seems to have a lesser impact.


Subject(s)
COVID-19 , Prostatic Neoplasms , Ad26COVS1 , COVID-19/prevention & control , COVID-19 Vaccines/adverse effects , Choline/analogs & derivatives , Cohort Studies , Fluorodeoxyglucose F18 , Gallium Isotopes , Gallium Radioisotopes , Humans , Lymph Nodes/diagnostic imaging , Lymph Nodes/pathology , Male , Positron Emission Tomography Computed Tomography , Prostatic Neoplasms/diagnostic imaging , Prostatic Neoplasms/pathology , Radiopharmaceuticals , Vaccination
2.
Pediatr Infect Dis J ; 41(5): e246-e248, 2022 05 01.
Article in English | MEDLINE | ID: covidwho-1853265

ABSTRACT

A 6-year-old boy with autistic spectrum disorder was diagnosed with tuberculosis infection following contact tracing of his mother who had isoniazid-resistant pulmonary tuberculosis. He progressed to develop mediastinal lymphadenopathy causing a persistent cough. He was too small to undergo endobronchial ultrasound-guided biopsy. As an alternative, he underwent esophageal endoscopic ultrasound-guided biopsy, leading to confirmation of the diagnosis. We believe this approach to diagnostic biopsy is underrecognized in pediatric practice, and highlight its utility with this case and a brief literature review.


Subject(s)
Lung Neoplasms , Tuberculosis , Bronchoscopy , Child , Endoscopic Ultrasound-Guided Fine Needle Aspiration , Humans , Lung Neoplasms/pathology , Lymph Nodes/diagnostic imaging , Lymph Nodes/pathology , Male , Mediastinum/diagnostic imaging , Mediastinum/pathology , Tuberculosis/pathology , Ultrasonography
3.
J Med Imaging Radiat Sci ; 53(2): 219-225, 2022 06.
Article in English | MEDLINE | ID: covidwho-1851589

ABSTRACT

PURPOSE: First discovered in Wuhan, China in December 2019, severe acute respiratory syndrome coronavirus 2 (SARS-COV-2) is a highly contagious and deadly novel virus that quickly wreaked havoc throughout the world. As mass vaccination are now underway worldwide, clinicians have started to encounter a new clinical entity, COVID-19 vaccine-associated axillary lymphadenopathy. This presents a unique challenge to medical imagers, particularly in oncologic patients. METHODS: In this retrospective study, we assessed metabolic activity, size, and timeline of COVID-19 vaccine-associated axillary hypermetabolic lymph nodes in 202 oncologic patients post vaccination with 18-fluorodeoxyglucose positron emission tomography (18-FDG PET). RESULTS: When present, COVID-19 vaccine-associated hypermetabolic lymph nodes demonstrate a mean maximum standard uptake value (SUVmax) of 2.5 ± 0.3, and more common in younger patients. The metabolic activity is the most intense in the first two weeks post vaccination and diminishes over time. By approximately 5-6 weeks, only about half of the patients demonstrated appreciable, low grade uptake compared to background. CONCLUSION: Based on our preliminary results, we would recommend correlation with a history and time of vaccination and routine use of a pre-study patient questionnaire to guide interpretation to prevent over-diagnosis of axillary nodal metastases and/or unnecessary work-up in oncologic patients.


Subject(s)
COVID-19 Vaccines , COVID-19 , COVID-19/prevention & control , Humans , Lymph Nodes/diagnostic imaging , Positron Emission Tomography Computed Tomography/methods , Retrospective Studies , SARS-CoV-2 , Vaccination
4.
Heart Lung ; 54: 19-26, 2022.
Article in English | MEDLINE | ID: covidwho-1828554

ABSTRACT

BACKGROUND: The presence of mediastinal lymph node enlargement (MLNE) in computed tomography (CT) of Coronavirus disease 2019 (COVID-19) patients can be associated with disease severity. OBJECTIVES: To investigate the relationship between MLNE with intensive care unit admission (ICU), mortality rates, and CT findings, especially in early-stage COVID-19 patients. METHODS: This single-center retrospective case-control study, included aged ≥18 years, 250 COVID-19 patients with positive RT-PCR tests. We included two patient groups, 125/250 with and without MLNE. Demographic information of the patients, laboratory findings, length of stay in hospital or ICU, mortality rates, initial CT imaging findings and CT severity scores (CT-SS) were recorded and their relationship with MLNE was investigated. RESULTS: Patients with MLNE were older (69.61 ± 11.16; p < 0.001) and had a higher CT-SS (14.67 ± 7.55; p < 0.001). There was a significant difference between the presence of MLNE with mortality (58/77, 75.3%; p < 0.001) and ICU admission (49/61, 80.3%; p < 0.001). Also, a statistical association was found between MLNE with ICU admission (p = 0.001) and (p < 0.001) mortality rates in patients with CORADS≤2 CT findings. In multivariate logistic regression analysis, MLNE was 8.8-fold (95% CI: 1.62-47.86, p =  0.01) more correlated with linear opacity and 0.25-fold with bronchial wall thickening (95% CI: 0.07-0.92, p =  0.04). CONCLUSION: Mediastinal lymph node enlargement is an important CT finding that can predict the severe prognosis of COVID-19 patients. Even in patients without lung involvement on initial CT, the presence of MLNE should be carefully examined as it is associated with disease severity.


Subject(s)
COVID-19 , Adolescent , Adult , Case-Control Studies , Humans , Lung , Lymph Nodes/diagnostic imaging , Lymph Nodes/pathology , Retrospective Studies , SARS-CoV-2 , Tomography, X-Ray Computed/methods
5.
Eur J Radiol ; 152: 110334, 2022 Jul.
Article in English | MEDLINE | ID: covidwho-1814377

ABSTRACT

BACKGROUND: Axillary lymph node characteristics on axillary ultrasound (US), breast MRI and 18F-FDG PET/CT are relevant at breast cancer diagnosis. Axillary lymphadenopathy after COVID-19 vaccination has been frequently reported. This may cause a diagnostic dilemma, particularly in the ipsilateral axilla in women who have a either a recent diagnosis of breast cancer or a history of breast cancer. This review provides an overview of the current evidence regarding axillary lymph node characteristics at breast cancer diagnosis versus "post-COVID-19 vaccination". METHODS: A non-systematic narrative review was performed. Studies describing axillary lymph node characteristics per imaging modality (axillary US, breast MRI and 18F-FDG PET/CT) in breast cancer patients versus post-COVID-19 vaccination were selected and used for the current study. RESULTS: The morphologic characteristics and distribution of abnormal nodes on US may differ from the appearance of metastatic adenopathy since diffuse cortical thickening of the lymph nodes is the most observed characteristic after vaccination, whereas metastases show as most suspicious characteristics focal cortical thickening and effacement of the fatty hilum. Current evidence on MRI and 18F-FDG on morphologic characteristics of axillary lymphadenopathy is missing, although it was suggested that vaccine related lymphadenopathy is more likely to be present in level 2 and 3 nodes than metastatic nodes. Reported frequencies of lymphadenopathy post-COVID-19 vaccination range from 49% to 85% (US), 29% (breast MRI) and 14.5% to 53.9% (18F-FDG PET/CT). Several factors may impact the presence or extent of lymphadenopathy post-COVID-19 vaccination: injection site, type of vaccine (i.e., mRNA versus vector), time interval (days) between vaccination and imaging, previous history of COVID-19 pneumonia, and first versus second vaccine dose. CONCLUSION: Although lymph node characteristics differ at breast cancer diagnosis versus post-COVID-19 vaccination, clinical information regarding injection site, vaccine type and vaccination date needs to be documented to improve the interpretation and guide treatment towards the next steps of action.


Subject(s)
Breast Neoplasms , COVID-19 , Lymphadenopathy , Axilla/pathology , Breast Neoplasms/diagnostic imaging , Breast Neoplasms/pathology , COVID-19/prevention & control , COVID-19 Vaccines/adverse effects , Female , Fluorodeoxyglucose F18 , Humans , Lymph Nodes/diagnostic imaging , Lymph Nodes/pathology , Lymphadenopathy/diagnostic imaging , Lymphadenopathy/etiology , Lymphadenopathy/pathology , Positron Emission Tomography Computed Tomography , Vaccination
6.
Acad Radiol ; 29(7): 1004-1012, 2022 07.
Article in English | MEDLINE | ID: covidwho-1705736

ABSTRACT

RATIONALE AND OBJECTIVE: To identify nodal features used to distinguish coronavirus disease 2019 (COVID-19) vaccine-Induced benign reactive adenopathy from malignant adenopathy. MATERIALS AND METHODS: This IRB-approved, single-institution, retrospective study compared features of 77 consecutive patients with benign adenopathy secondary to a messenger RNA COVID-19 vaccine with 76 patients with biopsy-proven malignant adenopathy from breast cancer. Patient demographics and nodal features were compared between the two groups using univariate and multivariate logistic regression models. A receiver operating characteristic analysis with the maximum value of Youden's index was performed for the cutoff value of cortical thickness for predicting nodal status. RESULTS: The mean cortical thickness was 5.1 mm ± 2.8 mm among benign nodes and 8.9 mm ± 4.5 mm among malignant nodes (p < 0.001). A cortical thickness ≥3.0 mm had a sensitivity of 100% and a specificity of 21% (area under the curve [AUC] = 0.60, 95% confidence interval [CI]: 0.52-0.68). When the cutoff for cortical thickness was increased to ≥5.4 mm, the sensitivity decreased to 74%, while the specificity increased to 69% (AUC = 0.77, 95% CI: 0.70-0.84).Cortical thickness correlated with nodal morphology type (r2 = 0.57). An axillary node with generalized lobulated cortical thickening had a 7.5 odds ratio and a node with focal cortical lobulation had a 123.0 odds ratio compared to one with diffuse, uniform cortical thickening only (p < 0.001). CONCLUSION: Cortical thickness and morphology are predictive of malignancy. Cortical thickness cutoff of ≥5.4 mm demonstrates higher specificity and improved accuracy for detecting malignant adenopathy than a cutoff of ≥3.0 mm.


Subject(s)
Breast Neoplasms , COVID-19 , Lymphadenopathy , Axilla/pathology , Breast Neoplasms/diagnostic imaging , Breast Neoplasms/pathology , COVID-19 Vaccines/adverse effects , Female , Humans , Lymph Nodes/diagnostic imaging , Lymph Nodes/pathology , Lymphadenopathy/diagnostic imaging , Lymphadenopathy/etiology , Retrospective Studies , Sensitivity and Specificity
7.
Medicina (Kaunas) ; 58(2)2022 Jan 27.
Article in English | MEDLINE | ID: covidwho-1686885

ABSTRACT

Background and Objectives: Several authors have reported cervical and axillary lymphadenopathies as known side effects following anti-COVID-19 vaccine administration. Few data are available about atypical locations of post-anti-COVID-19 vaccine lymphadenopathy. In this investigation, we evaluated the incidence and prevalence of postvaccine lymphadenopathy ultrasound (US) features in atypical sites. Materials and Methods: In this retrospective study, we retrospectively selected 64 patients on whom US was performed between January and October 2021 due to COVID-19 vaccine-related lymphadenopathy. We investigated lymph node anatomical sites, presence, number, size, shape, cortical profile, hilum outline, superb microvascular imaging (SMI), and elastosonography. Results: A total of 170 nodes were assessed. Atypical location was demonstrated in 5/64 patients (7.8%). In all these cases, atypical nodal involvement was associated with lymphadenopathy in a typical site (axillary, supraclavicular) ipsilateral to the vaccine injection site. Two patients presented lymphadenopathy in the infraclavicular station (3.1%), one in the pectoralis major muscle (1.6%), one in the left arm (1.6%), and one in the nuchal site (1.6%). All lymphadenopathies were oval-shaped, with a median size of 0.9 ± 0.2 cm. US features included a symmetric cortex with hilum evidence (4/6, 60%), vascular signal at SMI in both the hilar region and periphery of lymph node (5/6, 83.3%), and a US elastography pattern resembling that of adjacent tissues (5/6, 83.3%). The median age of patients with lymphadenopathies in an atypical location was 23 years. The main type of vaccine associated with lymph node appearance in atypical sites was Moderna's mRNA-1273 (60% of patients, 4/6 lymph nodes accounting for 66.7% among atypical locations). Conclusion: Post-COVID-19 vaccine administration lymphadenopathies in an atypical location represent an intense immune response to antigenic stimuli and they may show alarming US traits superimposed on malignant pathologies, which may complicate the patient's clinical and diagnostic pathway. Despite no distinctive US features between reactive post-COVID-19 vaccination and malignant lymph nodes being available, careful examination of atypical lymph node locations associated with accurate knowledge of patients' clinical background and delay of US exam to four to six weeks after vaccine injection should be considered.


Subject(s)
COVID-19 , Lymphadenopathy , Adult , COVID-19 Vaccines , Humans , Lymph Nodes/diagnostic imaging , Lymph Nodes/pathology , Lymphadenopathy/diagnostic imaging , Lymphadenopathy/epidemiology , Lymphadenopathy/etiology , Retrospective Studies , SARS-CoV-2 , Young Adult
8.
Clin Nucl Med ; 47(3): 275-276, 2022 Mar 01.
Article in English | MEDLINE | ID: covidwho-1672448

ABSTRACT

ABSTRACT: Since worldwide COVID-19 vaccination, 18F-FDG uptake in reactive axillary lymph nodes has been frequently observed in PET/CT studies. We describe a patient with breast cancer who underwent 18F-FDG PET/CT 7 days after receiving COVID-19 vaccination in the right thigh. 18F-FDG uptake was observed in nonenlarged right-sided inguinal, iliac, and para-aortic lymph nodes. As the thigh can be used as an alternate site for COVID-19 vaccine injection in case of lymphedema in both arms or for adequate axillary staging in patients with breast cancer, physicians should be aware of such 18F-FDG uptake pattern.


Subject(s)
COVID-19 Vaccines , COVID-19 , Fluorodeoxyglucose F18 , Humans , Lymph Nodes/diagnostic imaging , Positron Emission Tomography Computed Tomography , SARS-CoV-2 , Thigh/diagnostic imaging , Vaccination
9.
J Nucl Med Technol ; 50(1): 73-74, 2022 Mar.
Article in English | MEDLINE | ID: covidwho-1555926

ABSTRACT

Abnormally increased 18F-FDG avidity of axillary lymph nodes has become a frequent diagnostic dilemma on PET/CT in the current climate of global vaccinations directed against severe acute respiratory syndrome coronavirus 2. This avidity is due to the inflammatory response evoked by vaccines and the nonspecific nature of 18F-FDG uptake, which is increased in both malignant and inflammatory processes. Similarly, 18F-fluciclovine, an amino acid analog indicated for the assessment of biochemical recurrence of prostate cancer, may also demonstrate nonspecific inflammatory uptake. We report a case of 18F-fluciclovine PET/CT obtained for concern about prostate cancer. In this case, isolated avid lymph nodes were seen in the left axilla. A screening questionnaire revealed that the patient had recently received the second dose of the Pfizer-BioNTech coronavirus disease 2019 vaccine in his left shoulder, and hence, the uptake was determined to be reactive.


Subject(s)
COVID-19 , Prostatic Neoplasms , Axilla/pathology , COVID-19/prevention & control , COVID-19 Vaccines/adverse effects , Humans , Lymph Nodes/diagnostic imaging , Lymph Nodes/pathology , Male , Positron Emission Tomography Computed Tomography , Prostatic Neoplasms/diagnostic imaging , Prostatic Neoplasms/pathology , SARS-CoV-2 , Vaccination
10.
BMJ Case Rep ; 14(11)2021 Nov 17.
Article in English | MEDLINE | ID: covidwho-1522932

ABSTRACT

Follicular dendritic cell sarcoma is a rare low-grade sarcoma of mesenchymal origin. It involves the lymph nodes more commonly and rarely extranodal sites. The most common lymph node is cervical and usually presents as a painless asymptomatic mass. More often, it is a misdiagnosis, and there is a delay in treatment. It is rarely associated with Castleman disease, myasthenia gravis. Diagnosis of this condition is by histopathology and immunochemistry. Surgery is the primary modality of treatment, and adjuvant therapy has been tried with no definite trials due to the rarity of the disease. Here, we report a case of concomitant follicular dendritic sarcoma of the right cervical lymph node and papillary carcinoma of the thyroid managed in our institute. There was a line of investigations approaching towards a diagnosis, and she underwent total thyroidectomy and right modified radical neck dissection.


Subject(s)
Carcinoma, Papillary , Dendritic Cell Sarcoma, Follicular , Thyroid Neoplasms , Carcinoma, Papillary/surgery , Dendritic Cell Sarcoma, Follicular/diagnostic imaging , Dendritic Cell Sarcoma, Follicular/surgery , Female , Humans , Lymph Nodes/diagnostic imaging , Lymph Nodes/surgery , Lymphatic Metastasis , Neck Dissection , Thyroid Neoplasms/diagnosis , Thyroid Neoplasms/surgery , Thyroidectomy
11.
Clin Nucl Med ; 47(3): 275-276, 2022 Mar 01.
Article in English | MEDLINE | ID: covidwho-1475934

ABSTRACT

ABSTRACT: Since worldwide COVID-19 vaccination, 18F-FDG uptake in reactive axillary lymph nodes has been frequently observed in PET/CT studies. We describe a patient with breast cancer who underwent 18F-FDG PET/CT 7 days after receiving COVID-19 vaccination in the right thigh. 18F-FDG uptake was observed in nonenlarged right-sided inguinal, iliac, and para-aortic lymph nodes. As the thigh can be used as an alternate site for COVID-19 vaccine injection in case of lymphedema in both arms or for adequate axillary staging in patients with breast cancer, physicians should be aware of such 18F-FDG uptake pattern.


Subject(s)
COVID-19 Vaccines , COVID-19 , Fluorodeoxyglucose F18 , Humans , Lymph Nodes/diagnostic imaging , Positron Emission Tomography Computed Tomography , SARS-CoV-2 , Thigh/diagnostic imaging , Vaccination
14.
Ann Nucl Med ; 35(11): 1264-1269, 2021 Nov.
Article in English | MEDLINE | ID: covidwho-1378991

ABSTRACT

BACKGROUND: mRNA COVID-19 vaccines are known to provide an immune response seen on FDG PET studies. However, the time course of this metabolic response is unknown. We here present a temporal metabolic response to mRNA COVID-19 vaccination in oncology patients undergoing standard of care FDG PET. METHODS: 262 oncology patients undergoing standard of care FDG PET were included in the analysis. 231 patients had at least one dose of mRNA COVID-19 vaccine while 31 patients had not been vaccinated. The SUVmax of the lymph nodes ipsilateral to the vaccination was compared to the contralateral to obtain an absolute change in SUVmax (ΔSUVmax). RESULTS: ΔSUVmax was more significant at shorter times between FDG PET imaging and COVID-19 mRNA vaccination, with a median ΔSUVmax of 2.6 (0-7 days), 0.8 (8-14 days), and 0.3 (> 14 days), respectively. CONCLUSION: Consideration should be given to performing FDG PET at least 2 weeks after the COVID-19 vaccine.


Subject(s)
COVID-19 Vaccines/immunology , Neoplasms/immunology , Neoplasms/metabolism , Vaccines, Synthetic/immunology , Adult , Aged , Aged, 80 and over , Axilla , COVID-19/prevention & control , COVID-19 Vaccines/administration & dosage , Female , Fluorodeoxyglucose F18/metabolism , Humans , Lymph Nodes/diagnostic imaging , Lymph Nodes/immunology , Lymph Nodes/metabolism , Male , Middle Aged , Pectoralis Muscles , Positron Emission Tomography Computed Tomography , Time Factors , Vaccines, Synthetic/administration & dosage
15.
Melanoma Res ; 31(5): 490-493, 2021 10 01.
Article in English | MEDLINE | ID: covidwho-1371755

ABSTRACT

COVID-19 vaccination has been rapidly implemented among patients with cancer. We present the case of a patient with high-risk resected cutaneous melanoma, who was a candidate for adjuvant treatment, with postsurgery 18-fluorodeoxyglucose (FDG) PET/computed tomography (CT) scan showing positive axillary lymph nodes after COVID-19 vaccination. This report presents a 50-year-old man with a history of stage IIA cutaneous melanoma. During follow-up, the patient experienced subcutaneous and lymph-node disease progression, documented with 18FDG PET/CT scan. The patient underwent laparoscopic left para-aortic lymphadenectomy and excision of subcutaneous lesion. Histologic examination showed presence of melanoma metastases in 2 lymph nodes out of total 17 excised and neoplastic emboli to the subcutaneous tissue. In view of starting adjuvant nivolumab, the patient underwent CT scan restaging, with evidence of suspect centimetric periaortic and paracaval lymph nodes, which were deemed worthy of 18FDG PET investigation. The 18FDG PET/CT was negative for abdominal hypercaptation, but showed left axillary pathologic lymph nodes. The medical history of the patient revealed that he had received intramuscular Moderna COVID-19 mRNA vaccine in the left deltoid, one week before 18FDG PET examination. Since the patient's clinical examination was negative and suspecting postvaccination false-positive adenopathy, bilateral axillary ultrasound was performed, excluding the presence of pathologic lymph nodes. The patient has started adjuvant treatment with nivolumab, which is currently ongoing. This case demonstrates unexpected findings in response to COVID-19 vaccination in a patient with melanoma. In this specific case, the detection of 18FDG PET hypercaptation could significantly change the patient's management. With growing evidence about the pattern and occurrence of adenopathies after mRNA COVID-19 vaccination, recommendations for scheduling and interpretation of 18FDG PET/CT scans among cancer patients will be implemented, in order to reduce equivocal findings and improve outcomes.


Subject(s)
COVID-19 Vaccines/adverse effects , Lymph Nodes/pathology , Melanoma/pathology , COVID-19 Vaccines/administration & dosage , Disease Progression , Humans , Lymph Nodes/diagnostic imaging , Lymphatic Metastasis , Male , Melanoma/diagnostic imaging , Middle Aged
17.
AJR Am J Roentgenol ; 217(4): 831-834, 2021 10.
Article in English | MEDLINE | ID: covidwho-1352774

ABSTRACT

Early clinical experience with COVID-19 vaccination suggests that approved COVID-19 vaccines cause a notably higher incidence of axillary lymphadenopathy on breast MRI compared with other vaccines. Guidelines are needed to appropriately manage unilateral axillary lymphadenopathy detected by MRI in the era of COVID-19 vaccination and to avoid biopsies of benign reactive nodes. This article examines the available data on vaccine-related lymphadenopathy and offers a basic strategy for assessing axillary lymphadenopathy on MRI and guiding management. At our institution, we are adding questions regarding the date(s) and laterality of administration of COVID-19 vaccination to the intake form given to patients before all breast imaging examinations. We consider MRI-detected isolated unilateral axillary lymphadenopathy ipsilateral to the vaccination arm to most likely be related to the COVID-19 vaccine if it develops within 4 weeks of administration of either dose. In these cases, we assess the lymphadenopathy as BI-RADS 3 and recommend that follow-up ultrasound be performed within 6-8 weeks after administration of the second dose. These guidelines may be refined as we acquire further data on the expected time course of axillary lymphadenopathy after COVID-19 vaccination. Until that time, this management pathway will help avoid unnecessary biopsies of benign vaccine-related reactive lymphadenopathy.


Subject(s)
COVID-19 Vaccines/adverse effects , COVID-19/prevention & control , Lymphadenopathy/diagnostic imaging , Lymphadenopathy/etiology , Magnetic Resonance Imaging/methods , Adult , Axilla , COVID-19 Vaccines/therapeutic use , Female , Humans , Lymph Nodes/diagnostic imaging , Middle Aged , SARS-CoV-2
18.
J Nucl Med ; 63(3): 453-460, 2022 03.
Article in English | MEDLINE | ID: covidwho-1323063

ABSTRACT

Vaccination against coronavirus 2019 (COVID-19) has created new challenges. Lymphadenopathy with increased uptake in patients undergoing PET/CT may mislead to unnecessary further evaluation. We have analyzed routinely performed PET/CT studies after Pfizer-BioNTech vaccination to familiarize ourselves with the PET/CT appearance of various PET tracers and to prevent the consequences of misinterpretation. Methods: We analyzed 1,018 PET/CT studies performed between January 1, 2021, and February 15, 2021. Information about the dates and sites of vaccination was collected. Visual and semiquantitative analysis of axillary-neck lymphadenopathy and arm uptake was correlated with immunization data. Results: Increased uptake in axillary lymphadenopathy was observed unilaterally in 66% of vaccinated patients, in 55% of patients vaccinated once, and in 69% of those vaccinated twice. The intensity of uptake decreased over time. Fifty-four of 274 patients (20%) had simultaneous increased activity in the posterior arm and ipsilateral axillary lymphadenopathy (double sign [DS]). The sensitivity, specificity, positive predictive value, and negative predictive value were 55.4%, 83.6%, 86.7%, 49.2%, respectively, for axillary lymphadenopathy and 38.6%, 100%, 100%, and 66.1%, respectively, for DS. No DS was observed later than 10 and 21 d after the first and the second vaccinations, respectively. None of the nonvaccinated patients had arm uptake or DS. Conclusion: Vaccination against COVID-19 frequently causes nonspecific axillary lymphadenopathy with increased PET tracer activity. In one fifth of our study population, this lymphadenopathy was associated with increased uptake at the vaccination site, DS. DS was 100% specific, with a 100% positive predictive value for postvaccination lymphadenopathy, hence enabling avoidance of misinterpretation of PET/CT studies and further unnecessary evaluation.


Subject(s)
/immunology , COVID-19/prevention & control , Positron Emission Tomography Computed Tomography/methods , SARS-CoV-2/immunology , Vaccination , /adverse effects , Female , Fluorodeoxyglucose F18 , Humans , Lymph Nodes/diagnostic imaging , Lymphadenopathy/etiology , Male , Retrospective Studies
20.
AJR Am J Roentgenol ; 217(3): 584-586, 2021 09.
Article in English | MEDLINE | ID: covidwho-1320565

ABSTRACT

Reports of patients with axillary adenopathy identified on breast imaging after coronavirus disease (COVID-19) vaccination are rising. We propose a pragmatic management approach based on clinical presentation, vaccination delivery, and imaging findings. In the settings of screening mammography, screening MRI, and diagnostic imaging workup of breast symptoms, with no imaging findings beyond unilateral axillary adenopathy ipsilateral to recent (within the past 6 weeks) vaccination, we report the adenopathy as benign with no further imaging indicated if no nodes are palpable 6 weeks after the last dose. For patients with palpable axillary adenopathy in the setting of ipsilateral recent vaccination, clinical follow-up of the axilla is recommended. In all these scenarios, axillary ultrasound is recommended if clinical concern persists 6 weeks after vaccination. In patients with a recent breast cancer diagnosis in the pre- or peritreatment setting, prompt recommended imaging is encouraged as well as vaccination (in the thigh or contralateral arm). Our recommendations align with the ACR BI-RADS Atlas and aim to reduce patient anxiety, provider burden, and costs of unnecessary evaluation of enlarged nodes in the setting of recent vaccinations and, also, to avoid further delays in vaccinations and breast cancer screening during the pandemic.


Subject(s)
Breast Neoplasms/diagnostic imaging , Breast/diagnostic imaging , COVID-19 Vaccines/adverse effects , Lymph Nodes/pathology , Lymphadenopathy/diagnostic imaging , Axilla/diagnostic imaging , Early Detection of Cancer , Female , Humans , Lymph Nodes/diagnostic imaging , Lymphadenopathy/etiology , Magnetic Resonance Imaging , Mammography , Ultrasonography , Vaccination
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