Department of Otolaryngology, Head & Neck Surgery, Whangarei Hospital, Whangarei, New Zealand.
Faculty of Medical and Health Sciences, The University of Auckland, Auckland, New Zealand.
ANZ J Surg. 2022 Sep;92(9):2286-2291. doi: 10.1111/ans.17808. Epub 2022 Jun 10.
COVID-19 is an evolving worldwide pandemic causing significant morbidity and mortality. COVID-19 vaccinations have been developed to increase immunity against the virus. In New Zealand, the Pfizer BioNTech mRNA vaccine has been provisionally approved for use. Axillary lymphadenopathy is a recognized side effect of the mRNA vaccine, however cervical lymphadenopathy has also been reported. Due to a wide range of differential diagnoses, the finding of cervical lymphadenopathy requires thorough investigation which can include imaging and invasive diagnostic procedures.
Five patients were identified by otorhinolaryngology (ORL) consultants at Whangarei Base Hospital and Waikato Hospital between 15/7/2021 and 21/12/2021 after being investigated through high suspicion of cancer triage pathways set by the New Zealand Ministry of Health. Inclusion criteria were adult patients with cervical lymphadenopathy following vaccination. Exclusion criteria were no history of vaccination or lymphadenopathy present before vaccination.
All patients were identified to have cervical lymphadenopathy on radiological imaging and a recent history of COVID-19 vaccination with the Pfizer BioNTech vaccine. Interval vaccination to fine needle aspiration time ranged between 41 and 76 days. All patients had cytological or histological diagnosis showing reactive findings or interval imaging showing resolution of lymphadenopathy.
With increasing levels of COVID-19 vaccination and booster vaccinations we will continue to see cases of COVID-19 vaccine associated cervical lymphadenopathy. We highlight the importance of taking a COVID-19 vaccination history and including COVID-19 associated cervical lymphadenopathy in the differential diagnosis of presentation with a neck lump.
COVID-19 是一种正在全球流行的传染病，可导致严重的发病率和死亡率。COVID-19 疫苗的研发目的是增强对该病毒的免疫力。在新西兰，辉瑞公司的 BNT162b2 mRNA 疫苗已临时获准使用。腋窝淋巴结病是 mRNA 疫苗的一种公认副作用，但也有报道称出现颈部淋巴结病。由于鉴别诊断范围广泛，发现颈部淋巴结病需要进行彻底的检查，包括影像学检查和有创性诊断程序。
在 2021 年 7 月 15 日至 12 月 21 日期间，Whangarei Base Hospital 和 Waikato Hospital 的耳鼻喉科顾问通过新西兰卫生部设定的高可疑癌症分诊途径对 5 名患者进行了调查，发现他们患有癌症。纳入标准为接种疫苗后出现颈部淋巴结病的成年患者。排除标准为无接种疫苗史或接种疫苗前存在淋巴结病。
所有患者均通过影像学检查发现颈部淋巴结病，且最近有 COVID-19 接种史，接种的是辉瑞 BNT162b2 疫苗。从接种到细针抽吸的间隔时间为 41 至 76 天。所有患者均有细胞学或组织学诊断结果，显示反应性发现，或间隔影像学检查显示淋巴结病消退。
随着 COVID-19 疫苗接种率和加强针接种率的提高，我们将继续看到与 COVID-19 疫苗相关的颈部淋巴结病病例。我们强调了在出现颈部肿块时询问 COVID-19 疫苗接种史的重要性，并将 COVID-19 相关的颈部淋巴结病纳入鉴别诊断。
