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      Prevalence of Increased FDG PET/CT Axillary Lymph Node Uptake Beyond 6 Weeks after mRNA COVID-19 Vaccination

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      Author(s): , MD, MSc 1 , 2 , , , MD, MSc 1 , 2 , , MD 1 , , MD 1 , , MD 1 , 2 , , MD, MSc 1 , 2
      Publication date (Electronic):
      Journal: Radiology
      Publisher: Radiological Society of North America

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          Abstract

          Ipsilateral avid axillary lymph node uptake at FDG PET/CT persists in 29% (49 of 169) of patients between 7 to 10 weeks after the second dose of the mRNA-based BNT162b2 COVID-19 vaccination.

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          Lymphadenopathy in COVID-19 Vaccine Recipients: Diagnostic Dilemma in Oncology Patients

          Can Ozutemiz, Luke A. Krystosek, An Church … (2021)
          Abstract We present five cases of axillary lymphadenopathy which occurred after COVID-19 vaccination and that mimicked metastasis in oncologic patients. Initial radiologic diagnosis raised concerns for metastasis. However, further investigation revealed that patients received COVID-19 vaccinations in the ipsilateral arm prior to imaging. In two cases, lymph node biopsy confirmed vaccination related reactive lymphadenopathy. Ipsilateral axillary swelling / lymphadenopathy was reported based on symptoms and physical examination in COVID-19 vaccine trials. Knowledge of the potential for COVID-19 vaccine-related ipsilateral adenopathy is necessary to avoid unnecessary biopsy and change in therapy.
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            Hypermetabolic lymphadenopathy following administration of BNT162b2 mRNA Covid-19 vaccine: incidence assessed by [ 18 F]FDG PET-CT and relevance to study interpretation

            Dan Cohen, Shir Krauthammer, Ido Wolf … (2021)
            Purpose Nationwide mass vaccination against Covid-19 started in Israel in late 2020. Soon we identified on [18F]FDG PET-CT studies vaccine-associated hypermetabolic lymphadenopathy (VAHL) in axillary or supraclavicular lymph nodes (ASLN) ipsilateral to the vaccination site. Sometimes, differentiation between the malignant and benign nature of the hypermetabolic lymphadenopathy (HLN) could not be made, and equivocal HLN (EqHL) was reported. The purpose of the study was to determine the overall incidence of VAHL after BNT162b2 vaccination and also its relevance to PET-CT interpretation in oncologic patients. Methods A total of 951 consecutive patients that underwent [18F]FDG PET-CT studies in our department were interviewed regarding the sites and dates of the vaccine doses. A total of 728 vaccinated patients (All-Vac group) were included: 346 received the first dose only (Vac-1 group) and 382 received the booster dose as well (Vac-2 group). Studies were categorized as no HLN, malignant-HLN (MHL), VAHL, or EqHL. In studies with VAHL, location, [18F]FDG-intensity uptake and nodes size were recorded. Results The incidences of HLN were 45.6%, 36.4%, and 53.9% in All-Vac, Vac-1, and Vac-2 groups, respectively. VAHL was reported in 80.1% of vaccinated patients with HLN. Lower incidences of VAHL were found during the first 5 days or in the third week after the first vaccine and beyond 20 days after the booster dose. In 49 of 332 (14.8%) vaccinated patients, we could not determine whether HLN was MHL or VAHL. Breast cancer and lymphoma were the leading diseases with EqHL. Conclusion VAHL is frequently observed after BNT162b2 administration, more commonly and with higher intensity following the booster dose. To minimize false and equivocal reports in oncological patients, timing of [18F]FDG PET-CT should be based on the time intervals found to have a lower incidence of VAHL, and choice of vaccine injection site should be advised, mainly in patients where ASLN are a relevant site of tumor involvement.
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              Multidisciplinary Recommendations Regarding Post-Vaccine Adenopathy and Radiologic Imaging: Radiology Scientific Expert Panel

              Anton Becker, Rocio Perez-Johnston, Sona A Chikarmane … (2021)
              Vaccination-associated adenopathy is a frequent imaging finding after administration of COVID-19 vaccines that may lead to a diagnostic conundrum in patients with manifest or suspected cancer, in whom it may be indistinguishable from malignant nodal involvement. To help the medical community address this concern in the absence of studies and evidence-based guidelines, this paper offers recommendations developed by a multidisciplinary panel of experts from three of the leading tertiary care cancer centers in the United States. According to these recommendations, some routine imaging examinations, such as those for screening, should be scheduled before or at least 6 weeks after the final vaccination dose to allow for any reactive adenopathy to resolve. However, there should be no delay of other clinically indicated imaging (e.g., for acute symptoms, short-interval treatment monitoring, urgent treatment planning or complications) due to prior vaccination. The vaccine should be administered on the side contralateral to the primary or suspected cancer, and both doses should be administered in the same arm. Vaccination information (date(s) administered, injection site(s), laterality, and type of vaccine) should be included in every pre-imaging patient questionnaire, and this information should be made readily available to interpreting radiologists. Clear and effective communication between patients, radiologists, referring physician teams and the general public should be considered of the highest priority when managing adenopathy in the setting of COVID-19 vaccination. Summary COVID-19-vaccination–related adenopathy is a frequent imaging finding that may lead to a diagnostic conundrum in patients with manifest or suspected cancer, in whom it may be indistinguishable from malignant nodal involvement. This special report offers recommendations developed by a multidisciplinary panel of experts from three of the leading tertiary care cancer centers in the United States.
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                Author and article information

                Contributors
                Yael Eshet:
                ORCID: https://orcid.org/0000-0002-8339-5823
                Noam Tau:
                ORCID: https://orcid.org/0000-0003-0849-1708
                Yousef Alhoubani:
                ORCID: https://orcid.org/0000-0001-5162-7856
                Nayroz Kanana
                Liran Domachevsky:
                ORCID: https://orcid.org/0000-0001-8038-8161
                Michal Eifer:
                ORCID: https://orcid.org/0000-0002-1111-7875
                Journal
                Journal ID (nlm-ta): Radiology
                Journal ID (iso-abbrev): Radiology
                Journal ID (publisher-id): Radiology
                Title: Radiology
                Publisher: Radiological Society of North America
                ISSN (Print): 0033-8419
                ISSN (Electronic): 1527-1315
                Publication date (Electronic): 27 April 2021
                Electronic Location Identifier: 210886
                Affiliations
                [1] 1Department of Diagnostic Imaging, Chaim Sheba Medical Center, Ramat Gan, Israel
                [2] 2Sackler Faculty of Medicine, Tel-Aviv University, Tel Aviv, Israel
                Author notes
                Corresponding author: Yael Eshet, MD, MSc yael.eshet@ 123456gmail.com Department of Diagnostic Imaging, Chaim Sheba Medical Center, Sheba road 2, 52621, Ramat Gan, Israel
                Eshet Yael, MD, MSc Yael.Eshet@ 123456sheba.health.gov.il Department of Diagnostic Imaging, Chaim Sheba Medical Center, Ramat Gan, Israel Sackler Faculty of Medicine, Tel-Aviv University, Tel Aviv, Israel
                Tau Noam, MD taunoam@ 123456gmail.com Department of Diagnostic Imaging, Chaim Sheba Medical Center, Ramat Gan, Israel Sackler Faculty of Medicine, Tel-Aviv University, Tel Aviv, Israel
                Alhoubani Yousef, MD Yousef.Alhoubani@ 123456sheba.health.gov.il Department of Diagnostic Imaging, Chaim Sheba Medical Center, Ramat Gan, Israel
                Kanana Nayroz, MD Nayruz.Knaana@ 123456sheba.health.gov.il Department of Diagnostic Imaging, Chaim Sheba Medical Center, Ramat Gan, Israel Sackler Faculty of Medicine, Tel-Aviv University, Tel Aviv, Israel
                Domachevsky Liran, MD Liran.Domachevsky@ 123456sheba.health.gov.il Department of Diagnostic Imaging, Chaim Sheba Medical Center, Ramat Gan, Israel Sackler Faculty of Medicine, Tel-Aviv University, Tel Aviv, Israel
                Eifer Michal, MD, MSc michaleifer@ 123456gmail.com Resident (currently in training) Department of Diagnostic Imaging, Chaim Sheba Medical Center, Ramat Gan, Israel Sackler Faculty of Medicine, Tel-Aviv University, Tel Aviv, Israel
                Author information
                https://orcid.org/0000-0002-8339-5823
                https://orcid.org/0000-0003-0849-1708
                https://orcid.org/0000-0001-5162-7856
                https://orcid.org/0000-0001-8038-8161
                https://orcid.org/0000-0002-1111-7875
                Article
                Publisher-manuscript ID: 210886
                DOI: 10.1148/radiol.2021210886
                PMC ID: 8082565
                PubMed ID: 33904778
                SO-VID: 30642e90-2975-4dcc-8867-5de1f2733a93
                Copyright © 2021 by the Radiological Society of North America, Inc.
                License:

                This article is made available via the PMC Open Access Subset for unrestricted re-use and analyses in any form or by any means with acknowledgement of the original source. These permissions are granted for the duration of the COVID-19 pandemic or until permissions are revoked in writing. Upon expiration of these permissions, PMC is granted a perpetual license to make this article available via PMC and Europe PMC, consistent with existing copyright protections.

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                Subject: Original Research
                Subject: Research Letter

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