Department of Diagnostic Imaging, Chaim Sheba Medical Center, Ramat Gan, Israel; Sackler Faculty of Medicine, Tel-Aviv University, Tel Aviv, Israel; The Meirav High Risk Clinic, Sheba Medical Center, Ramat Gan, Israel.
Department of Diagnostic Imaging, Chaim Sheba Medical Center, Ramat Gan, Israel; Sackler Faculty of Medicine, Tel-Aviv University, Tel Aviv, Israel.
Acad Radiol. 2021 Sep;28(9):1191-1197. doi: 10.1016/j.acra.2021.06.003. Epub 2021 Jun 10.
Following vaccination of Israeli population with Pfizer-BioNTech COVID-19 Vaccine, an unusual increase in axillary-lymphadenopathy was noted. This study assesses the rate and magnitude of this trend from breast-imaging standpoint.
Participants undergoing breast-imaging, in whom isolated axillary-lymphadenopathy was detected were questioned regarding SARS-CoV-2 vaccine to the ipsilateral arm. Patients' and imaging characteristics were statistically compared. In order to perform a very short-term follow-up, twelve healthy vaccinated medical staff-members, underwent axillary-ultrasound shortly after the second dose, and follow-up.
Axillary-lymphadenopathy attributed to vaccination was found in 163 women undergoing breast-imaging, including BRCA-carriers. During the study, number of detected lymphadenopathies increased by 394% (p = 0.00001) in comparison with previous 2 consecutive years. Mean cortical-thickness of abnormal lymph-nodes after second dose vaccination was 5 ± 2 mm. Longer lymph-node diameter after second vaccination was noted (from 15 ± 5 mm, to 18 ± 6 mm, p = 0.005). In the subgroup of medical staff members, following trends were observed: in patients with positive antibodies, lymph-node cortical-thickness was larger than patients with negative serology (p = 0.03); lymph-node cortical-thickness decreased in 4-5 weeks follow-up (p = 0.007). Lymphadenopathy was evident on mammography in only 49% of cases.
Vaccine-associated lymphadenopathy is an important phenomenon with great impact on breast-imaging clinic workload. Results suggest the appearance of cortical thickening shortly after both doses. Positive serology is associated with increased lymph-node cortical-thickness. In asymptomatic vaccinated women with ipsilateral axillary-lymphadenopathy as the only abnormal finding, radiological follow-up is probably not indicated. BRCA-carriers, although at higher risk for breast-cancer, should probably receive the same management as average-risk patients.
在以色列人群接种辉瑞-生物科技公司的 COVID-19 疫苗后，注意到腋窝淋巴结病的异常增加。本研究从乳房成像的角度评估这种趋势的发生率和程度。
对接受乳房成像检查的患者进行询问，检查是否有孤立性腋窝淋巴结病，并将其与同侧手臂的 SARS-CoV-2 疫苗联系起来。对患者和影像学特征进行统计学比较。为了进行非常短期的随访，12 名接受过第二剂疫苗接种的健康接种医务人员在接种第二剂疫苗后不久进行了腋窝超声检查，并进行了随访。
在接受乳房成像检查的 163 名女性中，包括 BRCA 携带者，发现了与疫苗接种相关的腋窝淋巴结病。在研究期间，与前两年连续两年相比，检测到的淋巴结病数量增加了 394%（p=0.00001）。第二次疫苗接种后异常淋巴结皮质厚度的平均值为 5±2mm。第二次疫苗接种后，淋巴结直径较长（从 15±5mm 增加到 18±6mm，p=0.005）。在医务人员亚组中，观察到以下趋势：在抗体阳性的患者中，淋巴结皮质厚度大于血清学阴性的患者（p=0.03）；在 4-5 周的随访中，淋巴结皮质厚度下降（p=0.007）。仅在 49%的病例中，淋巴结病在乳房 X 线摄影中可见。
疫苗相关淋巴结病是一种重要的现象，对乳房成像诊所的工作量有很大的影响。结果表明，在两次接种后不久就出现了皮质增厚。血清学阳性与淋巴结皮质厚度增加有关。在同侧腋窝淋巴结病为唯一异常发现的无症状接种女性中，可能不需要进行放射学随访。BRCA 携带者，尽管患乳腺癌的风险较高，但可能需要与一般风险患者接受相同的管理。
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