Department of Radiology, Aga Khan University Hospital, Karachi, Pakistan.
Department of Heam-Oncology, Oklahoma University, Oklahoma, Pakistan.
Asian Pac J Cancer Prev. 2023 Dec 1;24(12):4053-4057. doi: 10.31557/APJCP.2023.24.12.4053.
BACKGROUND: In the current era vaccine-associated lymphadenopathy (VAL) is not an uncommon presentation on 18F-FDG PET/CT examinations in patients inoculated with Coronavirus disease 2019 (COVID-19) vaccination. In this study, we are presenting data of VAL on 18F-FDG PET/CT regarding its prevalence, temporal response to vaccination and imaging characteristics of VAL. METHODS: Seventy-eight (78) consecutive vaccinated breast cancer (BC) patients who had 18FDG PET/CT were retrospectively analyzed. All patients had COVID-19 vaccine shots in contralateral arms and none in breast cancer site axilla (BSA). In 35 patients 18FDG avid nodes were found in vaccine site axilla (VSA). In 25 patients 18FDG avid nodes were found in BSA. Morphological criteria on CT images like size, presence of fatty hila and fat stranding of axillary nodes were analyzed. Metabolic criteria on PET images like SUVmax of nodes and liver as reference were also measured. RESULTS: Out of 78 patients, 35 had positive nodes in VSA (45% prevalence) and 25/78 had BSA (33% prevalence). Mean duration of COVID-19 vaccination in each group was 8 ±04 week (non-significant p-value). On CT images, 18FDG avid nodes in VSA were significantly smaller (10 ± 03 mm) and with intact fatty hila without fat stranding than nodes in BSA with loss of fatty hila (25 ±10 mm; p <0.0001). Mean SUVmax of nodes in VSA was significantly lower (2.4 ±1.1) than nodes in BSA (10.2 ±5.5 - p-value <0.0001). Nodes in VSA showed a significant positive linear correlation between size and SUVmax (p-value 0.00001). Similarly, nodes in VSA showed a significant negative linear correlation between duration and SUVmax (p-value 0.00003). In VSA group, 03 patients having SUVmax >2 SD of Hepatic SUVmax were subjected to ultrasound guided fine needle aspiration (FNA) and turned out to be metastatic in nature. CONCLUSION: In COVID-19 vaccinated patients with BC, 18FDG avid nodes in VSA may pose diagnostic challenge. However, morphological (size < 10 mm short axis, intact fatty hila without fat stranding) and metabolic criteria (SUVmax <2.4 with negative correlation with time of inoculation) have higher diagnostic accuracy in resolving the dilemma. Nodes in VSA having SUVmax > 2 SD of hepatic SUVmax should be considered for FNA to rule out possible metastasis.
背景：在当前时代，接种新冠肺炎（COVID-19）疫苗的患者在接受 18F-FDG PET/CT 检查时，疫苗相关淋巴结病（VAL）并不少见。在本研究中，我们提供了关于 18F-FDG PET/CT 上 VAL 的患病率、对疫苗接种的时间反应和 VAL 影像学特征的数据。
方法：回顾性分析了 78 例连续接种乳腺癌（BC）疫苗的患者的 18FDG PET/CT 检查结果。所有患者均在对侧手臂接种了 COVID-19 疫苗，而在乳腺癌部位腋窝（BSA）均未接种。在 35 例患者中，在疫苗接种部位腋窝（VSA）发现了 18FDG 活性淋巴结。在 25 例患者中，在 BSA 中发现了 18FDG 活性淋巴结。分析了 CT 图像上的形态学标准，如大小、腋窝淋巴结脂肪门的存在和脂肪条纹。还测量了 PET 图像上的代谢标准，如淋巴结和肝脏的 SUVmax。
结果：在 78 例患者中，35 例 VSA 有阳性淋巴结（45%的患病率），25/78 例 BSA 有阳性淋巴结（33%的患病率）。每组 COVID-19 疫苗接种的平均持续时间为 8±04 周（无显著 p 值）。在 CT 图像上，VSA 中 18FDG 活性淋巴结明显较小（10±03mm），且脂肪门完整，无脂肪条纹，而 BSA 中淋巴结脂肪门消失（25±10mm；p<0.0001）。VSA 中淋巴结的平均 SUVmax 明显较低（2.4±1.1），而 BSA 中淋巴结的 SUVmax 较高（10.2±5.5-p 值<0.0001）。VSA 中淋巴结的大小与 SUVmax 之间呈显著正线性相关（p 值为 0.00001）。类似地，VSA 中淋巴结的 SUVmax 与接种时间之间呈显著负线性相关（p 值为 0.00003）。在 VSA 组中，有 3 例 SUVmax>2SD 肝 SUVmax 的患者接受了超声引导下细针抽吸（FNA），结果为转移性。
结论：在接种 COVID-19 疫苗的乳腺癌患者中，VSA 中的 18FDG 活性淋巴结可能会带来诊断挑战。然而，形态学（短轴<10mm，脂肪门完整，无脂肪条纹）和代谢标准（SUVmax<2.4，与接种时间呈负相关）在解决这一难题方面具有更高的诊断准确性。VSA 中 SUVmax>2SD 肝 SUVmax 的淋巴结应考虑进行 FNA，以排除可能的转移。
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