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Coronavirus disease 2019 (COVID-19) vaccination-induced unilateral axillary lymphadenopathy: case series with follow-up and literature review

  • Jeong Jae Kim (Department of Radiology, Jeju National University Hospital, Jeju National University College of Medicine) ;
  • Su Yeon Ko (Department of Radiology, Jeju National University Hospital, Jeju National University College of Medicine)
  • Received : 2023.01.26
  • Accepted : 2023.03.16
  • Published : 2023.06.30

Abstract

Multiple studies have reported on unilateral axillary adenopathy following coronavirus disease 2019 (COVID-19) vaccination, which is currently recognized as a common finding. Here, we present a series of eight adult patients with reactive axillary lymphadenopathy following COVID-19 vaccination, in whom the follow-up ultrasonography (US) showed resolution of a previously noted unilateral axillary adenopathy. From March 2021 to March 2022, 2,599 consecutive women underwent breast US in Jeju National University Hospital. We identified 10 patients with unilateral axillary lymphadenopathy following COVID-19 vaccination detected on the breast US. The 10 patients were recommended for follow-up US. Two patients were lost to follow-up, whereas the remaining eight patients underwent follow-up US, in whom resolution of the unilateral axillary lymphadenopathy was noted. Radiologists should be aware of evolving guidelines for evaluating and managing axillary lymphadenopathy to avoid false positive biopsies. Recent studies on lymphadenopathy following COVID-19 vaccination show that a prolonged duration until resolution is often observed. Therefore, a follow-up US examination at least 12 weeks after vaccination may be reasonable. Furthermore, management guidelines should include a risk-stratified approach considering both vaccination timing and the patient's overall risk of metastatic disease.

Keywords

References

  1. Lehman CD, D'Alessandro HA, Mendoza DP, Succi MD, Kambadakone A, Lamb LR. Unilateral lymphadenopathy after COVID-19 vaccination: a practical management plan for radiologists across specialties. J Am Coll Radiol 2021;18:843-52. https://doi.org/10.1016/j.jacr.2021.03.001
  2. National Center for Immunization and Respiratory Disease. Pfizer-BioNTech COVID-19 Vaccine Reactions & Adverse Events [Internet]. Atlanta: Centers for Disease Control and Prevention; c2021 [cited 2021 Jun 25]. Available from: https://www.cdc.gov/vaccines/covid-19/info-by-product/pfizer/reactogenicity.html.
  3. National Center for Immunization and Respiratory Disease. The Moderna COVID-19 Vaccine's Local Reactions, Systemic Reactions, Adverse Events, and Serious Adverse Events [Internet]. Atlanta: Centers for Disease Control and Prevention; c2021 [cited 2021 Feb 28]. Available from: https://www.cdc.gov/vaccines/covid-19/info-by-product/moderna/reactogenicity.html.
  4. Keshavarz P, Yazdanpanah F, Rafiee F, Mizandari M. Lymphadenopathy following COVID-19 vaccination: imaging findings review. Acad Radiol 2021;28:1058-71. https://doi.org/10.1016/j.acra.2021.04.007
  5. Dominguez JL, Eberhardt SC, Revels JW. Unilateral axillary lymphadenopathy following COVID-19 vaccination: a case report and imaging findings. Radiol Case Rep 2021;16:1660-4. https://doi.org/10.1016/j.radcr.2021.04.015
  6. Ahn RW, Mootz AR, Brewington CC, Abbara S. Axillary lymphadenopathy after mRNA COVID-19 vaccination. Radiol Cardiothorac Imaging 2021;3:e210008.
  7. Adin ME, Isufi E, Kulon M, Pucar D. Association of COVID-19 mRNA vaccine with ipsilateral axillary lymph node reactivity on imaging. JAMA Oncol 2021;7:1241-2. https://doi.org/10.1001/jamaoncol.2021.1794
  8. Faermann R, Nissan N, Halshtok-Neiman O, Shalmon A, Gotlieb M, Yagil Y, et al. COVID-19 vaccination induced lymphadenopathy in a specialized breast imaging clinic in Israel: analysis of 163 cases. Acad Radiol 2021;28:1191-7. https://doi.org/10.1016/j.acra.2021.06.003
  9. Mehta N, Sales RM, Babagbemi K, Levy AD, McGrath AL, Drotman M, et al. Unilateral axillary adenopathy in the setting of COVID-19 vaccine. Clin Imaging 2021;75:12-5. https://doi.org/10.1016/j.clinimag.2021.01.016
  10. Wolfson S, Kim E, Plaunova A, Bukhman R, Sarmiento RD, Samreen N, et al. Axillary adenopathy after COVID-19 vaccine: no reason to delay screening mammogram. Radiology 2022;303:297-9. https://doi.org/10.1148/radiol.213227
  11. Robinson KA, Maimone S, Gococo-Benore DA, Li Z, Advani PP, Chumsri S. Incidence of axillary adenopathy in breast imaging after COVID-19 vaccination. JAMA Oncol 2021;7:1395-7. https://doi.org/10.1001/jamaoncol.2021.3127
  12. Grimm L, Destounis S, Dogan B, Nicolson B, Dontchos B, Sonnenblick E, et al. SBI recommendations for the management of axillary adenopathy in patients with recent COVID-19 vaccination [Internet]. Okemos: Society of Breast Imaging, c2021 [cited 2021 Mar 14]. Available from: https://splf.fr/wp-content/uploads/2021/02/Society-of-breast-imaging-Recommendations-for-the-Management-of-Axillary-Adenopathy-in-Patients-with-Recent-COVID-19-Vaccination-Mis-en-ligne-par-la-Societe-francaise-de-radiologie-le-10-02-21.pdf.
  13. Lane EG, Eisen CS, Drotman MB, Dodelzon K, Mema E, Thomas C, et al. Time for resolution of COVID-19 vaccine-related axillary lymphadenopathy and associated factors. AJR Am J Roentgenol 2022;219:559-68. https://doi.org/10.2214/AJR.22.27687
  14. Lehman CD, Lamb LR, D'Alessandro HA. Mitigating the impact of coronavirus disease (COVID-19) vaccinations on patients undergoing breast imaging examinations: a pragmatic approach. AJR Am J Roentgenol 2021;217:584-6. https://doi.org/10.2214/AJR.21.25688
  15. Schiaffino S, Pinker K, Magni V, Cozzi A, Athanasiou A, Baltzer PAT, et al. Axillary lymphadenopathy at the time of COVID-19 vaccination: ten recommendations from the European Society of Breast Imaging (EUSOBI). Insights Imaging 2021;12:119.
  16. Becker AS, Perez-Johnston R, Chikarmane SA, Chen MM, El Homsi M, Feigin KN, et al. Multidisciplinary recommendations regarding post-vaccine adenopathy and radiologic imaging: radiology scientific expert panel. Radiology 2021;300:E323-7. https://doi.org/10.1148/radiol.2021210436
  17. Newfield L, Naschitz JE, Yeshurun D. BCG-induced axillary lymph-adenitis in the adult. Harefuah 1990;119:199-200.
  18. Bettini E, Locci M. SARS-CoV-2 mRNA vaccines: immunological mechanism and beyond. Vaccines (Basel) 2021;9:147.
  19. Lederer K, Castano D, Gomez Atria D, Oguin TH 3rd, Wang S, Manzoni TB, et al. SARS-CoV-2 mRNA vaccines foster potent antigen-specific germinal center responses associated with neutralizing antibody generation. Immunity 2020;53:1281-95.e5. https://doi.org/10.1016/j.immuni.2020.11.009
  20. Lane DL, Neelapu SS, Xu G, Weaver O. COVID-19 vaccine-related axillary and cervical lymphadenopathy in patients with current or prior breast cancer and other malignancies: cross-sectional imaging findings on MRI, CT, and PET-CT. Korean J Radiol 2021;22:1938-45. https://doi.org/10.3348/kjr.2021.0350
  21. Kim SJ, Park YM. Clinical importance and sonographic features of nonpalpable axillary lymphadenopathy identified on breast sonography in patients without malignancy. J Ultrasound Med 2015;34:2193-202. https://doi.org/10.7863/ultra.15.01056
  22. Zhou W, DeMartini WB, Ikeda DM. Frequency and outcomes of ipsilateral axillary lymphadenopathy after COVID-19 vaccination. JAMA Netw Open 2022;5:e2216172.
  23. Kadali RAK, Janagama R, Peruru S, Malayala SV. Side effects of BNT162b2 mRNA COVID-19 vaccine: a randomized, cross-sectional study with detailed self-reported symptoms from healthcare workers. Int J Infect Dis 2021;106:376-81. https://doi.org/10.1016/j.ijid.2021.04.047
  24. Yoshimoto N, Yanagi A, Takayama S, Sakamoto M, Tomoda K, Ishikawa K, et al. Timing and duration of axillary lymph node swelling after COVID-19 vaccination: Japanese case report and literature review. In Vivo 2022;36:1333-6. https://doi.org/10.21873/invivo.12834
  25. Ha SM, Chu AJ, Lee J, Kim SY, Lee SH, Yoen H, et al. US evaluation of axillary lymphadenopathy following COVID-19 vaccination: a prospective longitudinal study. Radiology 2022;305:46-53. https://doi.org/10.1148/radiol.220543
  26. Park JY, Lee JY, Yi SY. Axillary lymphadenopathy on ultrasound after COVID-19 vaccination and its influencing factors: a single-center study. J Clin Med 2022;11:238.
  27. Co M, Wong PCP, Kwong A. COVID-19 vaccine associated axillary lymphadenopathy - A systematic review. Cancer Treat Res Commun 2022;31:100546.
  28. Skawran S, Gennari AG, Dittli M, Treyer V, Muehlematter UJ, Maurer A, et al. [18F]FDG uptake of axillary lymph nodes after COVID-19 vaccination in oncological PET/CT: frequency, intensity, and potential clinical impact. Eur Radiol 2022;32:508-16. https://doi.org/10.1007/s00330-021-08122-2
  29. Eshet Y, Tau N, Alhoubani Y, Kanana N, Domachevsky L, Eifer M. Prevalence of increased FDG PET/CT axillary lymph node uptake beyond 6 weeks after mRNA COVID-19 vaccination. Radiology 2021;300:E345-7. https://doi.org/10.1148/radiol.2021210886
  30. Edmonds CE, Zuckerman SP, Conant EF. Reply to "unilateral axillary lymphadenopathy after coronavirus disease (COVID-19) vaccination". AJR Am J Roentgenol 2021;216:W28.