Abstract
Background
Axillary lymph node characteristics on axillary ultrasound (US), breast MRI and 18F-FDG PET/CT are relevant at breast cancer diagnosis. Axillary lymphadenopathy after COVID-19 vaccination has been frequently reported. This may cause a diagnostic dilemma, particularly in the ipsilateral axilla in women who have a either a recent diagnosis of breast cancer or a history of breast cancer. This review provides an overview of the current evidence regarding axillary lymph node characteristics at breast cancer diagnosis versus “post-COVID-19 vaccination”.
Methods
A non-systematic narrative review was performed. Studies describing axillary lymph node characteristics per imaging modality (axillary US, breast MRI and 18F-FDG PET/CT) in breast cancer patients versus post-COVID-19 vaccination were selected and used for the current study.
Results
The morphologic characteristics and distribution of abnormal nodes on US may differ from the appearance of metastatic adenopathy since diffuse cortical thickening of the lymph nodes is the most observed characteristic after vaccination, whereas metastases show as most suspicious characteristics focal cortical thickening and effacement of the fatty hilum. Current evidence on MRI and 18F-FDG on morphologic characteristics of axillary lymphadenopathy is missing, although it was suggested that vaccine related lymphadenopathy is more likely to be present in level 2 and 3 nodes than metastatic nodes. Reported frequencies of lymphadenopathy post-COVID-19 vaccination range from 49% to 85% (US), 29% (breast MRI) and 14.5% to 53.9% (18F-FDG PET/CT). Several factors may impact the presence or extent of lymphadenopathy post-COVID-19 vaccination: injection site, type of vaccine (i.e., mRNA versus vector), time interval (days) between vaccination and imaging, previous history of COVID-19 pneumonia, and first versus second vaccine dose.
Conclusion
Although lymph node characteristics differ at breast cancer diagnosis versus post-COVID-19 vaccination, clinical information regarding injection site, vaccine type and vaccination date needs to be documented to improve the interpretation and guide treatment towards the next steps of action.
【저자키워드】 magnetic resonance imaging, Ultrasound, cN0patients without suspicious axillary lymph node findings, patients without suspicious axillary lymph node findings, cN+patients with suspicious axillary lymph node findings, patients with suspicious axillary lymph node findings, USultrasound, MRImagnetic resonance imaging, 18F-FDGfluorodexoyglucose, fluorodexoyglucose, PET/CTpositron emission tomography / computed tomography, positron emission tomography / computed tomography, 【초록키워드】 COVID-19, Treatment, Vaccine, Breast cancer, vaccination, Pneumonia, diagnostic, Diagnosis, MRI, vaccine dose, Characteristics, COVID-19 vaccination, mRNA, Interpretation, women, distribution, characteristic, Evidence, Frequency, Lymph node, PET/CT, Axillary Lymphadenopathy, Factor, clinical information, injection, breast cancer patient, current, IMPROVE, Result, selected, reported, was performed, provide, suggested, cortical, fatty, ipsilateral, post-COVID-19 vaccination, 【제목키워드】 Characteristics, Evidence, Lymph node, breast cancer patient,