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1.
Cancer Treat Res Commun ; 31: 100546, 2022.
Article in English | MEDLINE | ID: covidwho-1734316

ABSTRACT

INTRODUCTION: ; COVID-19 vaccines are commonly administered intramuscularly to the arm. Axillary lymphadenopathy has been reported as an adverse event after COVID-19 vaccination. In patients with breast cancers who received COVID-19 vaccination, presence of ipsilateral (or contralateral) lymphadenopathy poses diagnostic dilemma. This systematic review aims to evaluate the incidence and clinical characteristics of vaccine associated axillary lymphadenopathy. METHODS: ; The systematic review was conducted with accordance to the PRISMA statement. The search terms used were "Vaccine" OR "Vaccination" AND "Lymphadenopathy" OR "Lymph node" AND "Covid-19″. RESULTS: ; 31 studies or reports were identified using the predefined keywords from the systematic review protocol. After excluding irrelevant papers (such as guidelines, reviews, opinions and commentaries), 10 studies or reports were included in the review.Pooled incidence of clinically detectable lymphadenopathy after COVID-19 vaccination was 91/22,532 (0.4%). Mean size of the vaccine associated axillary lymphadenopathy was 18.2 mm (Range 16 - 21 mm). Mean duration from vaccination to occurrence of axillary lymphadenopathy was 6.9 days (Range 2 - 18 days). In a study on 119 patients, enlarged axillary lymphadenopathy resolves in 4 to 5 weeks. CONCLUSION: ; Vaccine associated axillary lymphadenopathy is not uncommon. Management of it is based on multidisciplinary decision with patient demographics, vaccination history and radiological finding being taken into account. Additional imaging and biopsy may lead to unnecessary healthcare burden. Proper arrangement of vaccination and imaging regarding timing and laterality should be advocated to avoid confusion and patient anxiety.


Subject(s)
COVID-19 , Lymphadenopathy , Vaccines , COVID-19/prevention & control , COVID-19 Vaccines/adverse effects , Humans , Lymphadenopathy/epidemiology , Lymphadenopathy/etiology , Lymphadenopathy/pathology , SARS-CoV-2
2.
Eur J Cancer ; 159: 38-51, 2021 12.
Article in English | MEDLINE | ID: covidwho-1719648

ABSTRACT

PURPOSE: Over 1 billion doses of COVID-19 vaccines have been already administered across the United States, the United Kingdom and the European Union at the time of writing. Furthermore, 1.82 million booster doses have been administered in the US since 13th 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 the same on breast cancer diagnosis and management. METHODS: A literature search was performed - PubMed, Ovid Medline, Scopus, CINHAL, Springer Nature, ScienceDirect, Academic Search Premier 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, United Kingdom and the Mayo Clinic in Minnesota, United States of America, 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 and/or an imaging finding and then combined with clinical judgement when managing individual cases.


Subject(s)
Breast Neoplasms/diagnostic imaging , COVID-19 Vaccines/adverse effects , Lymphadenopathy/diagnostic imaging , Mammography , Positron Emission Tomography Computed Tomography , Vaccination/adverse effects , Breast Neoplasms/epidemiology , Breast Neoplasms/therapy , COVID-19 Vaccines/administration & dosage , Diagnosis, Differential , Diagnostic Errors , Female , Humans , Incidence , Lymphadenopathy/chemically induced , Lymphadenopathy/epidemiology , Predictive Value of Tests , Prognosis , Risk Assessment , Risk Factors , Time Factors
3.
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
4.
J Thorac Oncol ; 17(1): 154-159, 2022 01.
Article in English | MEDLINE | ID: covidwho-1596474

ABSTRACT

OBJECTIVES: Axillary lymphadenopathy from coronavirus disease 2019 (COVID-19) vaccine is an emerging phenomenon during unprecedented mass vaccinations, which can be incidentally found on computed tomography (CT) scans. This study investigated the incidence, predisposing factors, and imaging characteristics of vaccine-related axillary lymphadenopathy in patients with thoracic malignancy who underwent CT scans before and after COVID-19 vaccinations. METHODS: The study included patients with thoracic malignancies who received two doses of mRNA-based COVID-19 vaccinations and had prevaccine and postvaccine chest CT scans. Postvaccine chest CT scan results were reviewed for increase in size of lymph nodes in the axilla and subpectoral areas, comparing with the prevaccine scan results. The cases with lymphadenopathy were further reviewed independently by two radiologists referring to clinical information to find whether lymphadenopathy was attributed to the vaccinations. RESULTS: Vaccine-related axillary lymphadenopathy was noted in 21 of 232 patients (9.0%). The median short-axis diameter of the largest node was 7 mm (range: 5-14 mm). The median number of increased nodes was 4 (range: 1-10). The median time to the postvaccine scan revealing lymphadenopathy was 1.7 weeks (range: -2.9 to 6.6) from the second dose. Vaccine-related lymphadenopathy was noted more often in women than in men (18 of 144, 12.5% versus 3 of 88, 3.4%, respectively; p = 0.019) and with mRNA-1273 vaccines than BNT162b2 vaccines (6 of 28, 21% versus 15 of 204, 7.4%, respectively; p = 0.026). CONCLUSIONS: The incidence of lymphadenopathy was 9%, with a median onset time of 1.7 weeks after the second vaccine dose. Female sex and vaccine type (mRNA-1273 vaccine) were associated with higher frequency of lymphadenopathy, providing initial observations to inform further investigations in larger cohorts.


Subject(s)
COVID-19 , Lung Neoplasms , Lymphadenopathy , Thoracic Neoplasms , Causality , Female , Humans , Incidence , Lymphadenopathy/epidemiology , Lymphadenopathy/etiology , Male , SARS-CoV-2 , Vaccination/adverse effects
5.
J Laryngol Otol ; 135(11): 1025-1030, 2021 Nov.
Article in English | MEDLINE | ID: covidwho-1569188

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.


Subject(s)
COVID-19 Vaccines/adverse effects , COVID-19/prevention & control , Head and Neck Neoplasms/immunology , Lymphadenopathy/chemically induced , Lymphadenopathy/epidemiology , Adult , Aged , Aged, 80 and over , Female , Head and Neck Neoplasms/virology , Humans , Incidence , Male , Middle Aged , Neck/pathology , Neck/virology , Retrospective Studies , SARS-CoV-2
6.
Clin Med (Lond) ; 21(6): e633-e638, 2021 Nov.
Article in English | MEDLINE | ID: covidwho-1551860

ABSTRACT

OBJECTIVES: Reactive axillary lymph nodes (ALN) may occur post-COVID-19 vaccination. This may be confused with malignant nodal metastases on oncological imaging. We aimed to determine the reactive ALN incidence and duration on 18F-fluorodeoxyglucose positron emission tomography - computed tomography (18F-FDG PET-CT), and its relationship with gender, age and vaccine type. METHODS: A retrospective study was performed. Two-hundred and four eligible patients had 18F-FDG PET-CT between 01 January 2021 and 31 March 2021, post-vaccination with Pfizer-BioNTech or Oxford-AstraZeneca vaccine. Image analysis was performed on dedicated workstations. SPSS was used for statistical analysis. RESULTS: Thirty-six per cent of patients had reactive ALN until 10 weeks post-vaccination; reducing in frequency and intensity with time. Women were more likely to have reactive ALN compared with men. The frequency and intensity were higher in patients aged <65 years compared with those aged ≥65 years. However, no difference was found between both vaccine types in our study cohort. CONCLUSIONS: Physicians' awareness of COVID-19 vaccine-related reactive ALN on 18F-FDG PET-CT is important to avoid inappropriate upstaging of cancers.


Subject(s)
COVID-19 , Lymphadenopathy , COVID-19 Vaccines , Female , Fluorodeoxyglucose F18 , Humans , Incidence , Lymphadenopathy/diagnostic imaging , Lymphadenopathy/epidemiology , Male , Positron Emission Tomography Computed Tomography , Positron-Emission Tomography , Retrospective Studies , SARS-CoV-2
7.
Acad Radiol ; 29(4): 501-507, 2022 04.
Article in English | MEDLINE | ID: covidwho-1516986

ABSTRACT

BACKGROUND: Women who received a COVID-19 vaccination may display subclinical unilateral axillary lymphadenopathy on screening mammography, which can appear suspicious for malignancy, leading to additional diagnostic evaluation. PURPOSE: To evaluate the prevalence of subclinical unilateral axillary lymphadenopathy (sLAD) on screening mammogram in women who received either the first or second dose of the Pfizer-BioNTech (Pfizer) or Moderna COVID-19 vaccines compared to women who have not. MATERIALS AND METHODS: In this IRB-approved, HIPAA complaint study from 12/14/2020 to 4/14/2021, 1027 patients presented for screening mammography and met study inclusion criteria. Patients with history of baseline lymphadenopathy or prior cancer diagnosis were excluded. RESULTS: Of the 1027 women, 43 were recalled for unilateral sLAD. 34 women received a COVID-19 vaccination ipsilateral to the sLAD (Pfizer n=19, 44.2%; Moderna n=15, 34.9%), 9 did not (20.9%). Incidence of unilateral axillary sLAD was significantly higher (p-value<0.01) in those who received a COVID-19 vaccination within approximately 7 weeks preceding screening mammogram. 13.2% of patients who received the Pfizer vaccine and 9.5% of patients who received the Moderna vaccine developed sLAD. Moderna's vaccine elicited a more robust reaction in the elderly (Moderna 63.7 years vs. Pfizer 59.7 years). For both vaccines, sLAD resolved on average 46.5 days after the last COVID-19 vaccine (p=0.44). CONCLUSION: Women who have received either mRNA COVID-19 vaccines may benefit from scheduling their screening mammogram before vaccination or consider delaying screening mammography 8 weeks. While Pfizer may have an overall more robust immune response, Moderna may elicit a stronger immune response in elderly women. SUMMARY: Women who received a COVID-19 vaccination before screening mammography were significantly more likely to present with subclinical axillary lymphadenopathy than women who did not receive the vaccine. KEY RESULTS: 13.2% of women who received a Pfizer-BioNTech vaccine exhibited subclinical axillary lymphadenopathy compared to 9.5% of those who received the Moderna vaccine. Only 1.2 % of those who did not receive a vaccine presented with subclinical unilateral axillary lymphadenopathy. The average time of resolution of the lymphadenopathy on diagnostic mammogram was 46.5 days overall, with Pfizer-BioNTech taking 50.7 days and Moderna 41.5 days.


Subject(s)
Breast Neoplasms , COVID-19 , Lymphadenopathy , Aged , Breast Neoplasms/diagnostic imaging , Breast Neoplasms/epidemiology , COVID-19/epidemiology , COVID-19/prevention & control , COVID-19 Vaccines/adverse effects , Early Detection of Cancer , Female , Humans , Lymphadenopathy/chemically induced , Lymphadenopathy/diagnostic imaging , Lymphadenopathy/epidemiology , Mammography , SARS-CoV-2
8.
Acad Radiol ; 28(9): 1191-1197, 2021 09.
Article in English | MEDLINE | ID: covidwho-1263200

ABSTRACT

INTRODUCTION: Following vaccination of Israeli population with Pfizer-BioNTech COVID-19 Vaccine, an unusual increase in axillary-lymphadenopathy was noted. This study assesses the rate and magnitude of this trend from breast-imaging standpoint. MATERIALS AND METHODS: Participants undergoing breast-imaging, in whom isolated axillary-lymphadenopathy was detected were questioned regarding SARS-CoV-2 vaccine to the ipsilateral arm. Patients' and imaging characteristics were statistically compared. In order to perform a very short-term follow-up, twelve healthy vaccinated medical staff-members, underwent axillary-ultrasound shortly after the second dose, and follow-up. RESULTS: Axillary-lymphadenopathy attributed to vaccination was found in 163 women undergoing breast-imaging, including BRCA-carriers. During the study, number of detected lymphadenopathies increased by 394% (p = 0.00001) in comparison with previous 2 consecutive years. Mean cortical-thickness of abnormal lymph-nodes after second dose vaccination was 5 ± 2 mm. Longer lymph-node diameter after second vaccination was noted (from 15 ± 5 mm, to 18 ± 6 mm, p = 0.005). In the subgroup of medical staff members, following trends were observed: in patients with positive antibodies, lymph-node cortical-thickness was larger than patients with negative serology (p = 0.03); lymph-node cortical-thickness decreased in 4-5 weeks follow-up (p = 0.007). Lymphadenopathy was evident on mammography in only 49% of cases. DISCUSSION: Vaccine-associated lymphadenopathy is an important phenomenon with great impact on breast-imaging clinic workload. Results suggest the appearance of cortical thickening shortly after both doses. Positive serology is associated with increased lymph-node cortical-thickness. In asymptomatic vaccinated women with ipsilateral axillary-lymphadenopathy as the only abnormal finding, radiological follow-up is probably not indicated. BRCA-carriers, although at higher risk for breast-cancer, should probably receive the same management as average-risk patients.


Subject(s)
Breast/diagnostic imaging , COVID-19 Vaccines/adverse effects , COVID-19 , Lymphadenopathy/chemically induced , Axilla , COVID-19/prevention & control , Female , Humans , Israel/epidemiology , Lymph Nodes , Lymphadenopathy/epidemiology , Vaccination/adverse effects
9.
Eur Rev Med Pharmacol Sci ; 25(9): 3607-3609, 2021 May.
Article in English | MEDLINE | ID: covidwho-1232732

ABSTRACT

Severe Acute Respiratory Syndrome Corona Virus-2 is the causative factor of Coronavirus Disease 2019. Early in the pandemic, mediastinal lymphadenopathy was not considered to be a significant radiologic finding of the SARS-COV-2 disease. Nevertheless, most recent studies associate mediastinal lymphadenopathy with more severe COVID-19 disease and poorer patient outcomes.


Subject(s)
COVID-19/epidemiology , Lymphadenopathy/epidemiology , Mediastinal Diseases/epidemiology , SARS-CoV-2 , COVID-19/diagnosis , COVID-19/immunology , Humans , Lymphadenopathy/diagnosis , Lymphadenopathy/immunology , Mediastinal Diseases/diagnosis , Mediastinal Diseases/immunology , Mediastinum/pathology , Prevalence , SARS-CoV-2/immunology
10.
J Med Virol ; 92(7): 891-902, 2020 07.
Article in English | MEDLINE | ID: covidwho-96725

ABSTRACT

OBJECTIVE: We systematically reviewed the computed tomography (CT) imaging features of coronavirus disease 2019 (COVID-19) to provide reference for clinical practice. METHODS: Our article comprehensively searched PubMed, FMRS, EMbase, CNKI, WanFang databases, and VIP databases to collect literatures about the CT imaging features of COVID-19 from 1 January to 16 March 2020. Three reviewers independently screened literature, extracted data, and assessed the risk of bias of included studies, and then, this meta-analysis was performed by using Stata12.0 software. RESULTS: A total of 34 retrospective studies involving a total of 4121 patients with COVID-19 were included. The results of the meta-analysis showed that most patients presented bilateral lung involvement (73.8%, 95% confidence interval [CI]: 65.9%-81.1%) or multilobar involvement (67.3%, 95% CI: 54.8%-78.7%) and just little patients showed normal CT findings (8.4%). We found that the most common changes in lesion density were ground-glass opacities (68.1%, 95% CI: 56.9%-78.2%). Other changes in density included air bronchogram sign (44.7%), crazy-paving pattern (35.6%), and consolidation (32.0%). Patchy (40.3%), spider web sign (39.5%), cord-like (36.8%), and nodular (20.5%) were common lesion shapes in patients with COVID-19. Pleural thickening (27.1%) was found in some patients. Lymphadenopathy (5.4%) and pleural effusion (5.3%) were rare. CONCLUSION: The lung lesions of patients with COVID-19 were mostly bilateral lungs or multilobar involved. The most common chest CT findings were patchy and ground-glass opacities. Some patients had air bronchogram, spider web sign, and cord-like. Lymphadenopathy and pleural effusion were rare.


Subject(s)
Betacoronavirus/pathogenicity , Clinical Laboratory Techniques/methods , Coronavirus Infections/diagnostic imaging , Lymphadenopathy/diagnostic imaging , Pandemics , Pleural Effusion/diagnostic imaging , Pneumonia, Viral/diagnostic imaging , Betacoronavirus/genetics , Biomarkers/analysis , COVID-19 , COVID-19 Testing , China/epidemiology , Coronavirus Infections/complications , Coronavirus Infections/diagnosis , Coronavirus Infections/epidemiology , Humans , Lung/diagnostic imaging , Lung/pathology , Lymphadenopathy/complications , Lymphadenopathy/epidemiology , Pleural Effusion/complications , Pleural Effusion/epidemiology , Pneumonia, Viral/complications , Pneumonia, Viral/epidemiology , Retrospective Studies , SARS-CoV-2 , Severity of Illness Index , Tomography, X-Ray Computed
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