Is short-term follow-up suitable clinical approach for MRI-detected adenopathy after COVID-19 vaccination?
USA: Adenopathy after COVID-19 vaccination is a frequent event; short-term follow-up is a suitable clinical approach, except in patients with current ipsilateral breast cancer, states a recent study in European Radiology. Often, adenopathy may persist 4–8 weeks after the vaccine's second dose, thus favoring follow-up periods.
Joao V. Horvat, Department of Radiology, Memorial Sloan Kettering Cancer Center, New York, NY, USA, and colleagues conducted the study with an objective to evaluate the frequency of ipsilateral axillary adenopathy following COVID-19 vaccination in patients who underwent breast MRI at a comprehensive cancer center. Additionally, possible variables associated with the incidence of adenopathy and the outcomes of patients with abnormal lymph nodes were also investigated in a retrospective cohort study.
For this purpose, databases were queried for patients who underwent breast MRI following COVID-19 vaccination from January 22, 2021, to March 21, 2021. Evaluation of the frequency of ipsilateral axillary adenopathy and possible associated variables including age, personal history of ipsilateral breast cancer, type of vaccine, clinical indication for breast MRI, number of doses, side of vaccination, and number of days between the vaccine and the MRI exam. The outcomes of the adenopathy were investigated, including the duration of adenopathy and biopsy results.
The study included a total of 357 patients.
Given below are the study's key findings:
- The frequency of adenopathy on breast MRI was 29% (104/357 patients).
- Younger patients and shorter time intervals from the second dose of the vaccine were significantly associated with the development of adenopathy.
- Most adenopathy resolved or decreased on follow-up, with 11% of patients presenting persistence of adenopathy up to 64 days after the second dose of the vaccine.
- Metastatic axillary carcinoma was diagnosed in three patients; all three had a current ipsilateral breast cancer diagnosis.
"Ipsilateral axillary adenopathy following COVID-19 mRNA-based vaccination is a frequent event and was seen in 29% of patients after either the first or second dose," wrote the authors. "Younger patients are more prone for developing adenopathy while as the time goes by after the vaccine's second dose, the frequency reduces."
"After the second dose of the vaccine, adenopathy may often persist for 4–8 weeks thus favoring follow-up periods that are equal to or greater than 8 weeks, they added. Short-term follow-up is an appropriate clinical approach in most cases, except in patients with current ipsilateral breast cancer for which standard management of the axilla is still recommended, they conclude.
Reference:
Horvat, J.V., Sevilimedu, V., Becker, A.S. et al. Frequency and outcomes of MRI-detected axillary adenopathy following COVID-19 vaccination. Eur Radiol (2022). https://doi.org/10.1007/s00330-022-08655-0
KEYWORDS: European Radiology, COVID-19 vaccination, vaccine, side effects, adenopathy, Joao V Horvat, breast neoplasms, magnetic resonance imaging, breast MRI, mRNA COVID-19 vaccination, axillary adenopathy, ipsilateral breast cancer, MRI
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