Wilpert Caroline, Wenkel Evelyn, Baltzer Pascal Andreas Thomas, Fallenberg Eva Maria, Preibsch Heike, Sauer Stephanie Tina, Siegmann-Luz Katja, Weigel Stefanie, Wunderlich Petra, Wessling Daniel
Department of Diagnostic and Interventional Radiology, University Medical Center Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany.
Radiology, Radiologie München, Munich, Germany.
Rofo. 2025 Mar;197(3):288-297. doi: 10.1055/a-2328-7536. Epub 2024 Jun 21.
Axillary lymphadenopathy (LA) after COVID-19 vaccination is now known to be a common side effect. In these cases, malignancy cannot always be excluded on the basis of morphological imaging criteria.Narrative review for decision-making regarding control and follow-up intervals for axillary LA according to currently published research. This article provides a practical overview of the management of vaccine-associated LA using image examples and a flowchart and provides recommendations for follow-up intervals. A particular focus is on patients presenting for diagnostic breast imaging. The diagnostic criteria for pathological lymph nodes (LN) are explained.Axillary LA is a common adverse effect after COVID-19 vaccination (0.3-53%). The average duration of LA is more than 100 days. LA is also known to occur after other vaccinations, such as the seasonal influenza vaccine. Systematic studies on this topic are missing. Other causes of LA after vaccination (infections, autoimmune diseases, malignancies) should be considered for the differential diagnosis. If the LA persists for more than 3 months after COVID-19 vaccination, a primarily sonographic follow-up examination is recommended after another 3 months. A minimally invasive biopsy of the LA is recommended if a clinically suspicious LN persists or progresses. In the case of histologically confirmed breast cancer, a core biopsy without a follow-up interval is recommended regardless of the vaccination, as treatment appropriate to the stage should not be influenced by follow-up intervals. For follow-up after breast cancer, the procedure depends on the duration of the LA and the woman's individual risk of recurrence.Vaccination history should be well documented and taken into account when evaluating suspicious LN. Biopsy of abnormal, persistent, or progressive LNs is recommended. Preoperative staging of breast cancer should not be delayed by follow-up. The risk of false-positive findings is accepted, and the suspicious LNs are histologically examined in a minimally invasive procedure. · The vaccination history must be documented (vaccine, date, place of application).. · If axillary LA persists for more than 3 months after vaccination, a sonographic follow-up examination is recommended after 3 months.. · Enlarged LNs that are persistent, progressive in size, or are suspicious on control sonography should be biopsied.. · Suspicious LNs should be clarified before starting oncological therapy, irrespective of the vaccination status, according to the guidelines and without delaying therapy.. · Wilpert C, Wenkel E, Baltzer PA et al. Vaccine-associated axillary lymphadenopathy with a focus on COVID-19 vaccines. Rofo 2025; DOI 10.1055/a-2328-7536.
现在已知新冠病毒疫苗接种后腋窝淋巴结病（LA）是一种常见的副作用。在这些病例中，不能总是根据形态学影像标准排除恶性肿瘤。根据当前发表的研究对腋窝LA的控制和随访间隔进行决策的叙述性综述。本文使用影像示例和流程图对疫苗相关LA的管理提供了实用概述，并给出了随访间隔的建议。特别关注进行乳腺诊断性成像的患者。解释了病理性淋巴结（LN）的诊断标准。腋窝LA是新冠病毒疫苗接种后的常见不良反应（0.3%-53%）。LA的平均持续时间超过100天。LA在其他疫苗接种后也会出现，如季节性流感疫苗。目前缺少关于该主题的系统性研究。接种疫苗后LA的其他原因（感染、自身免疫性疾病、恶性肿瘤）应在鉴别诊断时予以考虑。如果新冠病毒疫苗接种后LA持续超过3个月，建议在再过3个月后进行首次超声随访检查。如果临床可疑的LN持续存在或进展，建议对LA进行微创活检。对于组织学确诊的乳腺癌，无论是否接种疫苗，建议进行粗针活检且无需随访间隔，因为应根据分期进行的治疗不应受随访间隔影响。对于乳腺癌后的随访，程序取决于LA的持续时间和女性个体的复发风险。评估可疑LN时应详细记录疫苗接种史并予以考虑。建议对异常、持续或进展的LN进行活检。乳腺癌的术前分期不应因随访而延迟。接受假阳性结果的风险，并通过微创程序对可疑LN进行组织学检查。·必须记录疫苗接种史（疫苗、日期、接种地点）。·如果接种疫苗后腋窝LA持续超过3个月，建议在3个月后进行超声随访检查。·持续存在、大小进展或超声检查可疑的肿大LN应进行活检。·无论疫苗接种状况如何，应根据指南在开始肿瘤治疗前明确可疑LN情况，且不应延迟治疗。·威尔珀特C、温克尔E、巴尔策尔PA等。以新冠病毒疫苗为重点的疫苗相关腋窝淋巴结病。《德国放射学杂志》2025年；DOI 10.1055/a - 2328 - 7536。
