Department of Radiology and Biomedical Imaging, Yale School of Medicine, New Haven, Connecticut, .
Departments of Radiology, University of Missouri, Columbia, Missouri.
Nucl Med Commun. 2024 Jun 1;45(6):474-480. doi: 10.1097/MNM.0000000000001833. Epub 2024 Mar 11.
To compare the incidence and natural course of reactive axillary lymph nodes (RAL) between mRNA and attenuated whole-virus vaccines using Deauville criteria.
In this multi-institutional PET-CT study comprising multiple vaccine types (Pfizer-BioNTech/Comirnaty, Moderna/Spikevax, Sinovac/CoronaVac and Janssen vaccines), we evaluated the incidence and natural course of RAL in a large cohort of oncological patients utilizing a standardized Deauville scaling system (n=522; 293 Female, Deauville 3-5 positive for RAL). Univariate and multivariate analyses were conducted to evaluate the predictive value of clinical parameters (absolute neutrophil count [ANC], platelets, age, sex, tumor type, and vaccine-to-PET interval) for PET positivity.
Pfizer-BioNTech/Comirnaty and Moderna vaccines revealed similar RAL incidences for the first 20 days after the second dose of vaccine administration (44% for the first 10 days for both groups, 26% vs. 20% for 10-20 days, respectively for Moderna and Pfizer). However, Moderna recipients revealed significantly higher incidences of RAL after 20 days compared to Pfizer-BioNTech/Comirnaty, with nodal reactivity spanning up to the 9th week post-vaccination (15% vs. 4%, respectively P < 0.001). No RAL was observed in patients who received either a single dose of J&J vaccine or two doses of CroronaVac. Younger patients showed increased likelihood of RAL, otherwise, clinical/demographic parameters were not predictive of RAL ( P = 0.014 for age, P > 0.05 for additional clinical/demographic parameters).
RAL based on strict PET criteria was observed with mRNA but not with attenuated whole-virus vaccines, in line with higher immunogenicity and stronger protection offered by mRNA vaccines.
使用 Deauville 标准比较 mRNA 和减毒全病毒疫苗的反应性腋窝淋巴结（RAL）发生率和自然病程。
在这项包括多种疫苗类型（辉瑞/Comirnaty、莫德纳/Spikevax、科兴/CoronaVac 和杨森疫苗）的多机构 PET-CT 研究中，我们利用标准化的 Deauville 评分系统评估了大量肿瘤患者 RAL 的发生率和自然病程（n=522；293 名女性，RAL 的 Deauville 3-5 阳性）。进行了单变量和多变量分析，以评估临床参数（绝对中性粒细胞计数[ANC]、血小板、年龄、性别、肿瘤类型和疫苗至 PET 间隔）对 PET 阳性的预测价值。
在第二次疫苗接种后 20 天内，辉瑞/Comirnaty 和莫德纳疫苗的 RAL 发生率相似（前 10 天两组各为 44%，10-20 天分别为 26%和 20%）。然而，与辉瑞/Comirnaty 相比，莫德纳疫苗接种者在 20 天后的 RAL 发生率显著更高，淋巴结反应可延续至疫苗接种后第 9 周（分别为 15%和 4%，P ＜0.001）。接受 J&J 疫苗单剂或科兴疫苗两剂接种的患者均未观察到 RAL。年轻患者 RAL 的可能性增加，否则，临床/人口统计学参数不能预测 RAL（年龄的 P 值=0.014，其他临床/人口统计学参数的 P 值＞0.05）。
基于严格 PET 标准的 RAL 仅见于 mRNA 疫苗，而不见于减毒全病毒疫苗，与 mRNA 疫苗提供的更高免疫原性和更强保护作用一致。
