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

Breast radiologists are increasingly seeing patients with axillary adenopathy related to COVID-19 vaccination. Vaccination can cause levels I–III axillary as well as cervical lymphadenopathy. Appropriate management of vaccine-related adenopathy may vary depending on clinical context. In patients with current or past history of malignancy, vaccine-related adenopathy can be indistinguishable from nodal metastasis. This article presents imaging findings of oncology patients with adenopathy seen in the axilla or neck on cross-sectional imaging (breast MRI, CT, or PET-CT) after COVID-19 vaccination. Management approach and rationale is discussed, along with consideration on strategies to minimize false positives in vaccinated cancer patients. Time interval between vaccination and adenopathy seen on breast MRI, CT, or PET-CT is also reported.

[1]  M. Orevi,et al.  Lessons Learned from Post–COVID-19 Vaccination PET/CT Studies , 2021, The Journal of Nuclear Medicine.

[2]  M. Plaza,et al.  COVID-19 vaccine-related unilateral axillary lymphadenopathy: Pattern on screening breast MRI allowing for a benign assessment , 2021, Clinical Imaging.

[3]  V. Treyer,et al.  [18F]FDG uptake of axillary lymph nodes after COVID-19 vaccination in oncological PET/CT: frequency, intensity, and potential clinical impact , 2021, European Radiology.

[4]  Y. Eshet,et al.  Prevalence of Increased FDG PET/CT Axillary Lymph Node Uptake Beyond 6 Weeks after mRNA COVID-19 Vaccination , 2021, Radiology.

[5]  C. Lehman,et al.  Unilateral Lymphadenopathy After COVID-19 Vaccination: A Practical Management Plan for Radiologists Across Specialties , 2021, Journal of the American College of Radiology.

[6]  A. Bankier,et al.  COVID-19 Vaccination-Related Uptake on FDG PET/CT: An Emerging Dilemma and Suggestions for Management. , 2021, AJR. American journal of roentgenology.

[7]  H. Hricak,et al.  Multidisciplinary Recommendations Regarding Post-Vaccine Adenopathy and Radiologic Imaging: Radiology Scientific Expert Panel , 2021, Radiology.

[8]  C. Lehman,et al.  Mitigating the Impact of Coronavirus Disease (COVID-19) Vaccinations on Patients Undergoing Breast Imaging Examinations: A Pragmatic Approach. , 2021, AJR. American journal of roentgenology.

[9]  Yang Lu,et al.  COVID-19 mRNA Vaccination-Induced Lymphadenopathy Mimics Lymphoma Progression on FDG PET/CT. , 2021, Clinical nuclear medicine.

[10]  Christine E. Edmonds,et al.  Management of Unilateral Axillary Lymphadenopathy Detected on Breast MRI in the Era of Coronavirus Disease (COVID-19) Vaccination. , 2021, AJR. American journal of roentgenology.

[11]  Y. Eshet,et al.  Imaging of COVID-19 Vaccination at FDG PET/CT , 2021, Radiology.

[12]  A. Gholamrezanezhad,et al.  COVID-19 vaccine is here: practical considerations for clinical imaging applications , 2021, Clinical imaging.

[13]  I. Acevedo-Báñez,et al.  Contralateral Axillary Lymph Node Metastasis in a Patient with Relapsed Breast Cancer: Locoregional Event or Distant Metastasis Disease? , 2021, Oncology Research and Treatment.

[14]  Xinchen Sun,et al.  Therapeutic options for contralateral axillary lymph node metastasis in breast cancer. , 2021, Current problems in cancer.

[15]  Phoebe E. Freer.  The Impact of the COVID-19 Pandemic on Breast Imaging , 2020, Radiologic Clinics of North America.

[16]  K. Kichikawa,et al.  Axillary lymph node accumulation on FDG-PET/CT after influenza vaccination , 2012, Annals of Nuclear Medicine.

[17]  I. Burger,et al.  Incidence and Intensity of F-18 FDG Uptake After Vaccination With H1N1 Vaccine , 2011, Clinical nuclear medicine.