Cohen Dan, Krauthammer Shir Hazut, Wolf Ido, Even-Sapir Einat
Department of Nuclear Medicine, Tel-Aviv Sourasky Medical Center, 6 Weizmann St, 6423906, Tel Aviv, Israel.
Institute of Oncology, Tel-Aviv Sourasky Medical Center, 6 Weizmann St, 6423906, Tel Aviv, Israel.
Eur J Nucl Med Mol Imaging. 2021 Jun;48(6):1854-1863. doi: 10.1007/s00259-021-05314-2. Epub 2021 Mar 27.
Nationwide mass vaccination against Covid-19 started in Israel in late 2020. Soon we identified on [F]FDG PET-CT studies vaccine-associated hypermetabolic lymphadenopathy (VAHL) in axillary or supraclavicular lymph nodes (ASLN) ipsilateral to the vaccination site. Sometimes, differentiation between the malignant and benign nature of the hypermetabolic lymphadenopathy (HLN) could not be made, and equivocal HLN (EqHL) was reported. The purpose of the study was to determine the overall incidence of VAHL after BNT162b2 vaccination and also its relevance to PET-CT interpretation in oncologic patients.
A total of 951 consecutive patients that underwent [F]FDG PET-CT studies in our department were interviewed regarding the sites and dates of the vaccine doses. A total of 728 vaccinated patients (All-Vac group) were included: 346 received the first dose only (Vac-1 group) and 382 received the booster dose as well (Vac-2 group). Studies were categorized as no HLN, malignant-HLN (MHL), VAHL, or EqHL. In studies with VAHL, location, [F]FDG-intensity uptake and nodes size were recorded.
The incidences of HLN were 45.6%, 36.4%, and 53.9% in All-Vac, Vac-1, and Vac-2 groups, respectively. VAHL was reported in 80.1% of vaccinated patients with HLN. Lower incidences of VAHL were found during the first 5 days or in the third week after the first vaccine and beyond 20 days after the booster dose. In 49 of 332 (14.8%) vaccinated patients, we could not determine whether HLN was MHL or VAHL. Breast cancer and lymphoma were the leading diseases with EqHL.
VAHL is frequently observed after BNT162b2 administration, more commonly and with higher intensity following the booster dose. To minimize false and equivocal reports in oncological patients, timing of [F]FDG PET-CT should be based on the time intervals found to have a lower incidence of VAHL, and choice of vaccine injection site should be advised, mainly in patients where ASLN are a relevant site of tumor involvement.
2020年末以色列开始全国范围的新冠病毒疫苗大规模接种。很快我们在[F]FDG PET-CT研究中发现，在接种部位同侧腋窝或锁骨上淋巴结（ASLN）出现了与疫苗相关的代谢增高性淋巴结病（VAHL）。有时，代谢增高性淋巴结病（HLN）的良恶性难以区分，于是报告了不明确的HLN（EqHL）。本研究的目的是确定BNT162b2疫苗接种后VAHL的总体发生率及其与肿瘤患者PET-CT解读的相关性。
对在我科接受[F]FDG PET-CT检查的951例连续患者进行了关于疫苗接种部位和日期的访谈。共纳入728例接种疫苗的患者（全接种组）：346例仅接受了第一剂疫苗（Vac-1组），382例还接受了加强剂量（Vac-2组）。研究分为无HLN、恶性HLN（MHL）、VAHL或EqHL。对于有VAHL的研究，记录其位置、[F]FDG摄取强度和淋巴结大小。
全接种组、Vac-1组和Vac-2组HLN的发生率分别为45.6%、36.4%和53.9%。在80.1%有HLN的接种患者中报告了VAHL。在接种第一剂疫苗后的前5天或第三周以及加强剂量后20天以后，VAHL的发生率较低。在332例接种患者中的49例（14.8%）中，我们无法确定HLN是MHL还是VAHL。乳腺癌和淋巴瘤是EqHL的主要相关疾病。
BNT162b2疫苗接种后经常观察到VAHL，加强剂量后更常见且强度更高。为尽量减少肿瘤患者的假阳性和不明确报告，[F]FDG PET-CT的检查时机应基于发现VAHL发生率较低的时间间隔，并且应建议选择疫苗注射部位，主要是在ASLN是肿瘤相关受累部位的患者中。
