Unilateral axillary Adenopathy in the setting of COVID-19 vaccine

doi:10.1016/j.clinimag.2021.01.016

Clinical Imaging

Volume 75, July 2021, Pages 12-15

https://doi.org/10.1016/j.clinimag.2021.01.016 Get rights and content

Highlights

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Imaging features of new onset unilateral axillary adenopathy in recipients of COVID-19 vaccine are presented
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Recognition of recent COVID-19 vaccine status as a cause of unilateral axillary adenopathy is clinically relevant
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Short-term follow-up in the setting of unilateral axillary adenopathy and recent COVID-19 vaccine should be considered

Abstract

With the recent U.S. Food and Drug Administration (FDA)-approval and rollout of the Pfizer-BioNTech and Moderna COVID-19 vaccines, it is important for radiologists to consider recent COVID-19 vaccination history as a possible differential diagnosis for patients with unilateral axillary adenopathy. Hyperplastic axillary nodes can be seen on sonography after any vaccination but are more common after a vaccine that evokes a strong immune response, such as the COVID-19 vaccine. As the differential of unilateral axillary adenopathy includes breast malignancy, it is crucial to both thoroughly evaluate the breast for primary malignancy and to elicit history of recent vaccination. As COVID-19 vaccines will soon be available to a larger patient population, radiologists should be familiar with the imaging features of COVID-19 vaccine induced hyperplastic adenopathy and its inclusion in a differential for unilateral axillary adenopathy. Short-term follow-up for unilateral axillary adenopathy in the setting of recent COVID-19 vaccination is an appropriate recommendation, in lieu of immediately performing potentially unnecessary and costly axillary lymph node biopsies.

Introduction

With widespread rollout of the COVID-19 vaccine, it is prudent for radiologists to consider vaccine induced hyperplastic adenopathy as an etiology of unilateral axillary adenopathy seen on breast imaging. The recognition, description, and detection of new COVID-19 vaccination induced unilateral axillary adenopathy on breast imaging is presented in this case series. The differential diagnosis for unilateral axillary adenopathy is broad.[1], [2], [3] While it is imperative to exclude malignancy by thoroughly examining the ipsilateral breast, it is also important to consider various benign etiologies. One such benign differential diagnosis is recent vaccination history in the ipsilateral upper extremity, which has been documented in the literature as occurring shortly after receiving the smallpox, Bacille Calmette-Guerin (BCG), human papillomavirus (HPV), and H1N1 influenza A virus vaccines.[3], 4., [5], [6] In this case series, we present four patients who either presented with palpable unilateral adenopathy or were found to incidentally have unilateral axillary adenopathy during routine breast imaging. The four patients all had history of recent ipsilateral upper extremity vaccination with either the Pfizer-BioNTech or Moderna COVID-19 vaccine. All patients were in group 1a due to front line status and had no predisposing conditions.⁷ Radiologists should consider recent COVID-19 vaccination as a possible etiology, in particular given that the finding of unilateral axillary adenopathy is likely to become more prevalent with the rollout of the COVID-19 vaccines to the general population. The imaging presentation of COVID-19 induced hyperplastic unilateral axillary adenopathy is presented to familiarize radiologists with the imaging features and to raise consideration of this novel diagnosis. Recommendation of short-term follow-up for unilateral axillary adenopathy in the setting of recent COVID-19 vaccination should be considered, in lieu of immediately performing potentially unnecessary and costly axillary lymph node biopsies.

Section snippets

Case 1

59-year-old female, with no history of breast cancer, presented for evaluation of a palpable lump in her left axilla. Her family history is notable for a sister with breast cancer diagnosed at age 53.

Diagnostic left breast mammogram was unremarkable. Targeted sonography demonstrated a left axillary lymph node measuring 2.6 × 1.5 × 1.6 cm with uniform cortical thickening of 0.7 cm corresponding to the patient's palpable area of concern (Fig. 1a,b). The remainder of the left breast was

Discussion

The differential diagnosis for unilateral axillary adenopathy is broad with breast cancer at the top of the differential.[1], [2], [3] In evaluating patients presenting with a unilateral palpable axillary mass or incidental unilateral axillary adenopathy identified on routine breast imaging, it is imperative that the ipsilateral breast be thoroughly examined for possible primary malignancy. While malignancy remains the most serious differential for unilateral axillary adenopathy, other benign

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Comparison of Axillary Lymph Nodes on Breast MRI Before and After COVID-19 Booster Vaccination
2024, Academic Radiology
Vaccine-related lymphadenopathy is a frequent finding following initial coronavirus disease 2019 (COVID-19) vaccination, but the frequency after COVID-19 booster vaccination is still unknown. In this study we compare axillary lymph node morphology on breast MRI before and after COVID-19 booster vaccination.
This retrospective, single-center, IRB-approved study included patients who underwent breast MRI between October 2021 and December 2021 after the COVID-19 booster vaccination. The axillary lymph node with the greatest cortical thickness ipsilateral to the side of vaccination was measured on MRI after booster vaccination and before initial COVID-19 vaccination. Comparisons were made between patients with and without increase in cortical thickness of ≥ 0.2 cm. Continuous covariates were compared using Wilcoxon rank-sum test and categorical covariates were compared using Fisher's exact test. Multiple comparison adjustment was made using the Benjamini–Hochberg procedure.
All 128 patients were included. Twenty-four of 128 (19%) displayed an increase in lymph node cortical thickness of ≥ 0.2 cm. Patients who received the booster more recently were more likely to present cortical thickening, with a median of 9 days (IQR 5, 20) vs. 36 days (IQR 18, 59) (p < 0.001). Age (p = 0.5) and type of vaccine (p = 0.7) were not associated with thickening. No ipsilateral breast cancer or malignant lymphadenopathy were diagnosed on follow-up.
Axillary lymphadenopathy on breast MRI following COVID-19 booster vaccination is a frequent finding, especially in the first 3 weeks after vaccination. Additional evaluation or follow-up may be omitted in patients with low concern for malignancy.
To scan or not to scan: effect of scanning the axilla of all patients undergoing diagnostic breast ultrasound
2023, Clinical Imaging
Breast ultrasonography is a useful modality in patients undergoing diagnostic and screening breast imaging. However, breast ultrasound has a high false positive rate and can be time-consuming to perform.
The purpose of this study was to evaluate the clinical impact of incidental axillary findings found on diagnostic breast ultrasounds at a single multi-site institution that has a standard protocol of scanning the axilla for all breast ultrasound exams.
All diagnostic breast ultrasounds were retrospectively reviewed from January 2017 to September 2019. Follow-up imaging, relevant clinical history, and pathology results were also reviewed. All positive axillary findings were divided into incidental or non-incidental findings depending on whether there was a direct clinical indication to scan the axilla. Descriptive statistics were performed with a 5% level of significance.
Of the 19,695 diagnostic ultrasounds performed during this timeframe, there were 91 (0.5%) incidental axillary findings given a BIRADS category 3 or 4, and none of these findings resulted in the diagnosis of an occult breast cancer. One biopsy-proven SLL/CLL lymphoma was diagnosed that was otherwise clinically occult.
Routine axillary scanning in all patients undergoing a diagnostic breast ultrasound at a large multi-site institution yields a low rate of incidental findings and has minimal impact on detection of cancer.
Axillary lymphadenopathy following bivalent COVID-19 booster vaccination
2023, Clinical Imaging
Transient CA19-9 Elevation Post-COVID-19 Vaccine and Infection: A Case Series
2023, Gastro Hep Advances
Limiting Screening Mammography Recalls for Vaccine-Induced Adenopathy, a Single Institution Experience
2022, Academic Radiology
Reported incidence of vaccine-induced adenopathy varies widely, with higher estimates in early reports and small series. Objective was to evaluate a large sample of vaccinated patients undergoing screening mammography, to determine callback rates associated with vaccine-induced adenopathy and their outcomes.
Single-institution retrospective review of patients who received at least 1 dose of a COVID-19 vaccine prior to presentation for screening mammography from January 15 through May 31, 2021. Patient-related vaccination information (dose, brand, arm, date) was obtained by mammography technologists and available for interpreting radiologists. Patients recalled for axillary adenopathy were included; other causes for recall were excluded. Follow-up imaging and outcomes were tracked. Wilcoxon rank-sum test, Fisher exact test, multivariable logistic regression modeling, and receiver operating characteristic curve analyses were utilized. All tests were two-sided; p < 0.05 considered statistically significant.
Total of 2304 vaccinated patients underwent screening mammography; 24 (1.0%) recalled for ipsilateral adenopathy. There was no significant difference in presence of adenopathy associated with patient age, dose, or brand of vaccine. Presence of adenopathy significantly decreased as days from vaccination increased (p < 0.001). Receiver operating characteristic curve suggested 28.5 days as the best cutoff point to distinguish presence or absence of adenopathy on mammogram. Of 24 callbacks, 13 (54.2%) had benign results, 2 (8.3%) are still undergoing surveillance, and 9 (37.5%) are overdue for subsequent follow-ups. No cases resulted in biopsy or malignancy.
Low recall rates related to vaccine-induced adenopathy are achievable and can limit unnecessary workups, improve access, and promote flexible timing of vaccinations and screening exams.
Quantitative ultrasound image analysis of axillary lymph nodes to differentiate malignancy from reactive benign changes due to COVID-19 vaccination
2022, European Journal of Radiology
The aim of this study is to assess the potential of quantitative image analysis and machine learning techniques to differentiate between malignant lymph nodes and benign lymph nodes affected by reactive changes due to COVID-19 vaccination.
In this institutional review board–approved retrospective study, we improved our previously published artificial intelligence model, by retraining it with newly collected images and testing its performance on images containing benign lymph nodes affected by COVID-19 vaccination. All the images were acquired and selected by specialized breast-imaging radiologists and the nature of each node (benign or malignant) was assessed through a strict clinical protocol using ultrasound-guided biopsies.
A total of 180 new images from 154 different patients were recruited: 71 images (10 cases and 61 controls) were used to retrain the old model and 109 images (36 cases and 73 controls) were used to evaluate its performance. The achieved accuracy of the proposed method was 92.7% with 77.8% sensitivity and 100% specificity at the optimal cut-off point. In comparison, the visual node inspection made by radiologists from ultrasound images reached 69.7% accuracy with 41.7% sensitivity and 83.6% specificity.
The results obtained in this study show the potential of the proposed techniques to differentiate between malignant lymph nodes and benign nodes affected by reactive changes due to COVID-19 vaccination. These techniques could be useful to non-invasively diagnose lymph node status in patients with suspicious reactive nodes, although larger multicenter studies are needed to confirm and validate the results.

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Breast ImagingUnilateral axillary Adenopathy in the setting of COVID-19 vaccine

Highlights

Abstract

Introduction

Section snippets

Case 1

Discussion

A practical approach to imaging the axilla

Insights Imaging

Unilateral axillary adenopathy with unremarkable breast imaging-differential diagnoses

SAJR

Infectious diseases

Elsevier Health Sciences

Development of unilateral cervical and supraclavicular lymphadenopathy after human papilloma virus vaccination

Pharmacotherapy

Axillary lymph node accumulation on FDG-PET/CT after influenza vaccination

Ann Nucl Med

Breast Imaging
Unilateral axillary Adenopathy in the setting of COVID-19 vaccine