A 37-year-old woman developed a new, palpable left supraclavicular lymphadenopathy lump five days after her first dose of the Moderna COVID-19 vaccine in the left arm. On the day of vaccination, the patient was asymptomatic. This is an example of how the vaccine can mimic cancer and swollen lymph nodes.阅读关于这个案例研究的更多信息。图片经RSNA授权使用。
While the massCOVID-19过去4个月的疫苗接种工作使大流行隧道尽头的曙光更加接近，正如医学上的所有事情一样，这不是没有成本的。但这里的成本将是增加患者的焦虑，以及由于潜在的额外的、必要的检查而造成的经济损失。在过去的几个月里，同行评议文献和放射学会发出了几次警报，称COVID-19疫苗会导致一些患者出现暂时的炎症和淋巴结肿胀。虽然专家说这是正常的，但如果医生、放射科医生和患者没有意识到这种疫苗的出现，并认为这是感染或癌症的迹象，导致额外的诊断测试或后续检查，这可能是一个主要原因。
Lymphadenopathy, also called adenopathy, is when lymph nodes are abnormal in size or consistency. The most common inflammatory type is lymphadenitis, producing swollen or enlarged lymph nodes. However, it is causing alarm on mammograms of recently vaccinated women and can lead to additional tests and imaging if found in patients who undergo CT scans for any reason.
The development of lymphadenopathy after being vaccinated for COVID-19 is a sign of the body's immune system gearing up in response to the vaccine and will go away, the experts say.[1,2] It has been seen with other vaccines for the influenza and human papillomavirus, but the two-dose Pfizer-BioNTech and Moderna COVID vaccines appear to affect a much larger number of people. In the clinical trials for the the Moderna vaccine, axillary swelling or tenderness was reported in 11.6% of patients (5% with placebo) after dose 1, and 16% (4.3% with placebo) after Dose 2.[3] This greatly concerns radiologist who look at mammograms and review exams looking for cancer, or monitoring cancer treatment in patients.
This concern prompted an editorial in the Radiological Society of North America (RSNA) journalRadiology: Imaging Cancer发表在4月9日的文章中，解决了患者的担忧和诊断困境，因为淋巴结病可以在影像学检查中模仿癌症The authors of“COVID-19 Vaccination-Related Lymphadenopathy: What To Be Aware Of”point out that widespread patient education regarding vaccine-induced lymphadenopathy is needed. When vaccines are administered, side effects such as axillary swelling should be highlighted and normalized as an immune response initiated by the vaccine, they explain. The article also touches on the best times for patients to schedule imaging exams and offers follow-up recommendations.
“We write this editorial as a public service message at a time where other countries are starting mass vaccination programs with the goal of preventing unnecessary nodal biopsies and alleviating patient concern,” the authors wrote. “Imaging societies, clinicians and news media outlets should spread awareness to educate the public regarding this side effect to minimize patient anxiety.”
With mass vaccination rollout, the authors of the article said lymphadenopathy ipsilateral to the injected deltoid muscle has become an important manifestation of an immune response to be aware of as it may present as a diagnostic dilemma on cancer imaging studies. They said awareness will help the goal of preventing unnecessary nodal biopsies and alleviating patient concerns.
The article details the issue, what can be done and recaps the peer-review literature to date and guidelines issues since the start of vaccinations last December.
COVID Vaccine Can Lead to False Positive Mammograms
2022世界杯篮球预选赛赛程乳房影像学检查，筛查性乳房x线摄影、乳房超声和乳房MRI，均可显示淋巴结肿大的存在。这引起了人们的关注，并导致了一些建议，即在影像学检查之前，应询问女性是否接种了COVID-19疫苗。这促使乳腺成像学会(SBI)迅速发布了何时对接种COVID2022世界杯篮球预选赛赛程疫苗的女性进行成像的建议哈佛医学院和马萨诸塞州总医院放射科的女性健康影像专家也发表了相关建议
In a recentAmerican Journal of Roentgenology (AJR)article,Shabnam Mortazavi, M.D., of the University of California at Los Angeles reviewed electronic medical records to identify women with post-COVID-19 vaccination adenopathy found in breast imaging between December 2020 to February 2021.[7] Twenty-three women exhibited axillary adenopathy ipsilateral to the vaccinated arm on screening or diagnostic breast imaging, and according to Mortazavi, “13% were symptomatic (axillary lump with possible tenderness).” Meanwhile, the adenopathy was detected incidentally on screening breast imaging in 43% (mammography, 5; ultrasound, 2; both mammography and ultrasound, 1; high-risk screening MRI, 2) and on diagnostic imaging for other reasons in 43% (BI-RADS 3 follow-up for breast finding, 3; screening callback for other reason, 2; non-axillary breast pain or lump, 5). Noting that the median interval between the first vaccine dose and imaging showing the abnormal node was 9.5 days, Mortazavi’s results counted a total of 57% of women with one abnormal node. BI-RADS 2 was assigned in one woman, BI-RADS 3 in 21 (ultrasound in 4–24 weeks), and BI-RADS 4 in one.
"There was a lot of confusion on the best way to manage these types of patients," saidConstance "Connie" Lehman, M.D., Ph.D., lead author of the Mass General recommendations and chief of breast imaging, co-director of the Avon Comprehensive Breast Evaluation Center at the Massachusetts General Hospital, and professor of radiology at Harvard Medical School. "The first we tackled was a women who came in for a mammogram who had a recent COVID vaccination and had enlarged lymph nodes in the axilla on the same side she received the vaccine. So some were saying gosh, when we see this normally and we do not have a good explanation for this we are going to do a biopsy.Others said that is a bit to aggressive, lets bring them in for an ultrasound and we can do a short interval follow up until we show this is resolved and proving this is in fact not cancer, but just a temporary reaction to the vaccine. But, with the difficulties in getting patients to come in during COVID, we decided biopsies and short interval follow ups were not in our patients' best interest."
Instead, she said they based their recommendations for patients on the American College of Radiology (ACR) breast imaging and reporting recommendations, which state if you have a known inflammatory or infectious cause for unilateral axillary adenopathy, it is a benign BI-RADS 2 assessment.
"This has been reported over the decades with other vaccines, but it does seem the types of vaccines we are using for the COVID-19 virus prompts an even stronger response, which is why we are studying this so carefully," Lehman said. "We are carefully tracking this because we want to know how long this might persist on the mammograms or other imaging. We think 6 weeks is a reasonable estimate of how long we would expect to see enlarged lymph nodes on the mammogram, but we really don't know. We are in new territory now, so we are going to be carefully following patients. It could be up to two m months or more."
Should Imaging of Recently Vaccinated Patients be Delayed and for How Long?
Lehman said the Mass General guidelines and recently published paper included input from several imaging specialists in the department outside of breast imaging, because the concern of swollen lymph nodes run across all the subspecialties and may be found in other types of imaging. The rule of thumb they came up with for patients with enlarged lymph nodes who recently received the vaccine is to wait six weeks before following up with imaging exams if the swelling persists.
雷曼解释说:“对于任何已经安排好的成像，如果他们推迟或推迟，我们会根据检查的原因在论文中进行分解。”在接种疫苗前后或第二次接种后的六周内，可能会安排一些筛选试验。但在很多中心，这真的会给已经非常紧张的系统带来很多压力，所以我们认为人们应该在当地解读我们的指南，并与当地资源相适应。”
Read More:https://www.ajronline.org/doi/abs/10.2214/AJR.21.25688
TheSBI recommendationssay that patients should schedule screening mammograms exams prior to the first dose of a COVID-19 vaccination, or 4-6 weeks following the second dose of a COVID-19 vaccination.
What Are the Side Effects of COVID-19 vaccination?
TheRadiology: Imaging Cancer文章作者说，COVID-19疫苗最常见的副作用包括注射部位局部疼痛、发烧、发冷、肌痛、头痛和疲劳，通常在几天内消失。
There are three COVID-19 vaccines have been authorized by the U.S. Food and Drug Administration (FDA) for emergency use, the two-dose Pfizer and Moderna mRNA vaccines and the most recently authorized single dose Johnson and Johnson/Janssen adenovirus vector vaccine. Several other vaccines are in development or being distributed in other countries including those developed by Oxford-AstraZeneca (ChAdOx1 nCoV-19 or AZD1222), Gamaleya Research Institute of Epidemiology and Microbiology (Sputnik V), and the CanSinoBIO-Beijing Institute of Biotechnology (Convidicea or Ad5-nCoV). Through March 26, 2021, 526 million doses of vaccines have been distributed across the world.
Related COVID-19 Vaccine Radiology Content:
VIDEO: COVID Vaccine May Cause Enlarged Lymph Nodes on Mammograms— Interview with Constance "Connie" Lehman, M.D.
COVID-19 Vaccination Axillary Adenopathy Detected During Breast Imaging
PHOTO GALLERY: How COVID-19 Appears on Medical Imaging
CDC and FDA Call for Pause on Janssen COVID-19 Vaccine Due to Rare Blood Clots
Find more radiology related COVID content
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August 11, 2022
