Baylor University Medical Center, Radiology department at BUMC, 3500 Gaston Ave, Dallas, 75246, Texas; SimonMed Imaging, Statistics department at BUMC, Scottsdale, Arizona.
Baylor University Medical Center, Radiology department at BUMC, 3500 Gaston Ave, Dallas, 75246, Texas.
Acad Radiol. 2022 Apr;29(4):501-507. doi: 10.1016/j.acra.2021.11.010. Epub 2021 Nov 17.
Women who received a COVID-19 vaccination may display subclinical unilateral axillary lymphadenopathy on screening mammography, which can appear suspicious for malignancy, leading to additional diagnostic evaluation.
To evaluate the prevalence of subclinical unilateral axillary lymphadenopathy (sLAD) on screening mammogram in women who received either the first or second dose of the Pfizer-BioNTech (Pfizer) or Moderna COVID-19 vaccines compared to women who have not.
In this IRB-approved, HIPAA complaint study from 12/14/2020 to 4/14/2021, 1027 patients presented for screening mammography and met study inclusion criteria. Patients with history of baseline lymphadenopathy or prior cancer diagnosis were excluded.
Of the 1027 women, 43 were recalled for unilateral sLAD. 34 women received a COVID-19 vaccination ipsilateral to the sLAD (Pfizer n=19, 44.2%; Moderna n=15, 34.9%), 9 did not (20.9%). Incidence of unilateral axillary sLAD was significantly higher (p-value<0.01) in those who received a COVID-19 vaccination within approximately 7 weeks preceding screening mammogram. 13.2% of patients who received the Pfizer vaccine and 9.5% of patients who received the Moderna vaccine developed sLAD. Moderna's vaccine elicited a more robust reaction in the elderly (Moderna 63.7 years vs. Pfizer 59.7 years). For both vaccines, sLAD resolved on average 46.5 days after the last COVID-19 vaccine (p=0.44).
Women who have received either mRNA COVID-19 vaccines may benefit from scheduling their screening mammogram before vaccination or consider delaying screening mammography 8 weeks. While Pfizer may have an overall more robust immune response, Moderna may elicit a stronger immune response in elderly women.
Women who received a COVID-19 vaccination before screening mammography were significantly more likely to present with subclinical axillary lymphadenopathy than women who did not receive the vaccine.
13.2% of women who received a Pfizer-BioNTech vaccine exhibited subclinical axillary lymphadenopathy compared to 9.5% of those who received the Moderna vaccine. Only 1.2 % of those who did not receive a vaccine presented with subclinical unilateral axillary lymphadenopathy. The average time of resolution of the lymphadenopathy on diagnostic mammogram was 46.5 days overall, with Pfizer-BioNTech taking 50.7 days and Moderna 41.5 days.
在接受 COVID-19 疫苗接种的女性中，在筛查性乳房 X 光检查中可能会出现亚临床单侧腋窝淋巴结病，这可能对恶性肿瘤表现出可疑性，从而导致进一步的诊断评估。
评估在接受辉瑞-生物技术公司（Pfizer）或 Moderna COVID-19 疫苗的第一剂或第二剂疫苗接种的女性中，筛查性乳房 X 光检查中出现亚临床单侧腋窝淋巴结病（sLAD）的患病率，与未接种疫苗的女性相比。
在这项 2020 年 12 月 14 日至 2021 年 4 月 14 日获得机构审查委员会批准并符合 HIPAA 规定的研究中，有 1027 名患者接受了筛查性乳房 X 光检查并符合研究纳入标准。有基线淋巴结病或先前癌症诊断史的患者被排除在外。
在 1027 名女性中，有 43 名因单侧 sLAD 被召回。34 名女性在接受 sLAD 同侧接种了 COVID-19 疫苗（辉瑞，n=19，44.2%；Moderna，n=15，34.9%），9 名未接种疫苗（20.9%）。在接受 COVID-19 疫苗接种后大约 7 周内接受筛查性乳房 X 光检查的女性中，单侧腋窝 sLAD 的发生率明显更高（p 值<0.01）。接受辉瑞疫苗的患者中有 13.2%和接受 Moderna 疫苗的患者中有 9.5%出现 sLAD。Moderna 的疫苗在老年人中产生了更强烈的反应（Moderna 63.7 岁，辉瑞 59.7 岁）。对于两种疫苗，sLAD 在最后一次 COVID-19 疫苗接种后平均 46.5 天消退（p=0.44）。
接种过 mRNA COVID-19 疫苗的女性可能会受益于在接种疫苗之前安排筛查性乳房 X 光检查，或者考虑将筛查性乳房 X 光检查推迟 8 周。虽然辉瑞的免疫反应可能更加强烈，但 Moderna 可能会在老年女性中引起更强的免疫反应。
与未接种疫苗的女性相比，在接受筛查性乳房 X 光检查之前接种 COVID-19 疫苗的女性出现亚临床腋窝淋巴结病的可能性显著更高。
与接受 Moderna 疫苗的女性相比，接受辉瑞-生物技术公司疫苗的女性中有 13.2%出现亚临床腋窝淋巴结病。而未接种疫苗的女性中只有 1.2%出现亚临床单侧腋窝淋巴结病。淋巴结病在诊断性乳房 X 光片上的平均消退时间为 46.5 天，辉瑞-生物技术公司为 50.7 天，Moderna 为 41.5 天。
