Unilateral Axillary Lymphadenopathy Frequency and Follow-up Results After Inactivated COVID-19 Vaccination

Year 2024, , 132 - 138, 18.12.2024

Funda Dinç , Cenk Elibol , Murat Yunus Özdemir , Turhan Togan

https://doi.org/10.47572/muskutd.1407668

Abstract

Vaccine-induced ipsilateral axillary lymphadenopathy can be encountered with the widespread application of COVID-19 vaccines. The study aims to evaluate the frequency of axillary lymphadenopathy, sonographic features of axillary lymph nodes after administration of inactivated COVID-19 vaccine, and follow-up results. Between March and April 2021, a total of 127 participants were enrolled in this prospective study. Data were analyzed using both descriptive and exploratory test techniques with SPSS. A total of 127 participants (39.92±8.96 years, 68.5% men), who were between 10-16 days after the second dose vaccination, were evaluated for axillary lymph node status by initial ultrasound. A total of 32 participants (25.2%) had ipsilateral axillary lymphadenopathy in the initial ultrasound. Only one of these patients had persistent lymphadenopathy on the control ultrasound 30 days later. The widest cortical thickness was significantly higher on the ipsilateral side (2.63±2.12 mm) compared to the contralateral side (1.53±1.11 mm) (p<.001). The number of lymphadenopathies was higher on the vaccinated side compared to the contralateral side (p<.001). A significant relationship between the history of COVID-19 infection and the absence of ipsilateral lymphadenopathy was found (p<.001). As a local adverse effect, ipsilateral axillary lymphadenopathy following the second dose of inactivated COVID-19 vaccine can be seen, and it usually regresses within a month. However, during that period, axillary lymphadenopathy is not expected in vaccinated individuals who previously experienced COVID-19 infection. Awareness and questioning of both infection and vaccination history before radiological examinations involving the axilla should help the radiologist avoid the misinterpretation of lymphadenopathy. It should be kept in mind that vaccine-induced ipsilateral axillary lymphadenopathy can be seen after inactivated COVID-19 vaccines in individuals who don’t have a history of coronavirus infection, and it regresses a month later after detection.

Keywords

Vaccination, Covid-19, Cortical Thickness, Lymphadenopathy, Ultrasound

Ethical Statement

Muğla Üniversitesi Tıf Fakültesinden etik kurul onayı alındıktan sonra çalışma gerçekleştirilmiştir.

Supporting Institution

Mevcut değil.

İnaktive COVID-19 Aşısı Sonrası Unilateral Aksiller Lenfadenopati Sıklığı ve Takip Sonuçları

Abstract

Aşılarının yaygınlaşmasıyla birlikte aşıya bağlı ipsilateral aksiller lenfadenopati ile karşılaşılabilmektedir. Çalışmanın amacı inaktive COVİD-19 aşısı sonrası aksiller lenfadenopati sıklığını, lenf bezlerinin sonografik özelliklerini ve takip sonuçlarını değerlendirmektir. Mart-Nisan 2021 tarihleri arasında gerçekleştirilen prospektif çalışmaya toplam 127 katılımcı dahil edilmiştir. Tanımlayıcı ve çıkarımsal istatistiksel analizler SPSS kullanılarak gerçekleştirilmiştir. İkinci doz aşılamadan sonra 10-16 günlük süreçte 127 katılımcının (39.92±8.96 yaşında, %68.5'i erkek) ultrasonografi ile aksiller lenf nodu durumu değerlendirildi. Toplam 32 katılımcıda (%25.2) ilk ultrasonda ipsilateral aksiller lenfadenopati görüldü. Bu hastalardan yalnızca birinde 30 gün sonraki kontrol ultrasonda sebat eden lenfadenopati görüldü. Lenf nodu korteks kalınlığı en kalın yerinde aşılanan tarafta (2.63±2.12 mm) karşı tarafa (1.53±1.11 mm) göre anlamlı derecede yüksekti (p<.001). Lenfadenopati sayısı aşılanan tarafta karşı tarafa göre daha yüksekti (p<.001). Ayrıca COVİD-19 öyküsü ile ipsilateral lenfadenopati bulunmaması arasında anlamlı ilişki mevcuttu (p<.001). Lokal bir yan etki olarak inaktive COVİD-19 aşısının ikinci dozu sonrasında ipsilateral aksiller lenfadenopati görülebilmekte ve genellikle 1 ay içinde gerilemektedir. Ancak daha önce COVİD-19 enfeksiyonu geçiren bireylerde aşı sonrası aksiller lenfadenopati beklenmemektedir. Aksillayı ilgilendiren radyolojik incelemelerden önce hem enfeksiyon hem de aşılama geçmişinin bilinmesi, radyoloğun lenf nodu durumunu yanlış yorumlanmasını engelleyecektir. Aşıya bağlı ipsilateral aksiller lenfadenopatinin, koronavirus enfeksiyon öyküsü olmayan bireylerde inaktif COVİD-19 aşıları sonrasında görülebileceği ve tespit edildikten bir ay sonra çoğunlukla kaybolduğu akılda tutulmalıdır.

Keywords

Aşılama, Covid-19, Kortikal Kalınlık, Lenfadenopati, Ultrasonografi

Supporting Institution

Mevcut değil

References

• 1. Zhang Y, Zeng G, Pan H, et al. Safety, tolerability, and immunogenicity of an inactivated SARS-CoV-2 vaccine in healthy adults aged 18-59 years: arandomised, double-blind, placebo-controlled, phase 1/2 clinical trial. Lancet Infect Dis. 2021;21(2):181-92.
• 2. Lefebvre M, Vignier N, Pitard B, et al.; SPILF Vaccination Prevention group. COVID-19 vaccines: Frequently asked questions andupdated answers. Infect Dis Now. 2021;51(4):319-33.
• 3. Ioachim HL, Medeiros LJ. Ioachim’s Lymph Node Pathology. 4th ed. Philadelphia: Lippincott Williams & Wilkins; 1995. p.95-6.
• 4. McIntosh LJ, Bankier AA, Vijayaraghavan GR, et al. COVID-19 vaccination-related uptake on FDG PET/CT: an emerging dilemma and suggestions for management. AJR Am J Roentgenol. 2021;217(4):975-83.
• 5. Özütemiz C, Krystosek LA, Church AL, et al. Lymphadenopathy in COVID-19 vaccine recipients: diagnostic dilemma in oncologic patients. Radiol. 2021;300(1):E296-300.
• 6. Edmonds CE, Zuckerman SP, Conant EF. Management of unilateral axillary lymphadenopathy detected on breast MRI in the era of COVID-19 vaccination. AJR Am J Roentgenol. 2021;217(4):831-4.
• 7. Ahn RW, Mootz AR, Brewington CC, et al. Axillary lymphadenopathy after mRNA COVID-19 vaccination. Radiol Cardiothorac Imaging. 2021;3(1):e210008.
• 8. Keshavarz P, Yazdanpanah F, Rafiee F, et al. Lymphadenopathy following COVID-19 vaccination: ımaging findings review. Acad Radiol. 2021;28(8):1058-71.
• 9. IWC Wong, CWI Li, DKK Ng, et al. Inactivated and mRNA COVID-19 vaccines affect 18F-fluorodeoxyglucose positron emission tomography/computed tomography in oncology patients. Hong Kong J Radiol. 2022;25:94-102.
• 10. Elverici E, Özsoy A, Sayın A, et al. Unilateral axillary lymphadenopathy after the ınactivated SARS-COV-2 (CoronaVac) vaccine: ultrasonographic imaging. Balkan Med J. 2023;40(1):28-33.
• 11. Bedi DG, Krishnamurthy R, Krishnamurthy S, et al. Cortical morphologic features of axillary lymph nodes as a predictor of metastasis in breast cancer: in vitro sonographic study. AJR Am J Roentgenol. 2008;191(3):646-52.
• 12. Grimm L, Destounis S, Dogan B, et al. SBI recommendations for the management of axillary adenopathy in patients with recent COVID-19 vaccination. Reston: Society of Breast Imaging, 1891.
• 13. Igual-Rouilleault AC, Soriano I, Quan PL, et al. Unilateral axillary adenopathy induced by COVID-19 vaccine: US follow-up evaluation. Eur Radiol. 2021;16:1–8.
• 14. Mehta N, Sales RM, Babagbemi K, et al. Unilateral axillary Adenopathy in the setting of COVID-19 vaccine. Clin Imaging. 2021;75:12-5.
• 15. Schiaffino S, Pinker K, Magni V, et al. Axillary lymphadenopathy at the time of COVID-19 vaccination: ten recommendations from the European Society of Breast Imaging (EUSOBI). Insights Imaging. 2021;12(1):119.