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Wilpert C, Wenkel E, Baltzer PAT, Fallenberg EM, Preibsch H, Sauer ST, Siegmann-Luz K, Weigel S, Wunderlich P, Wessling D. Vaccine-associated axillary lymphadenopathy with a focus on COVID-19 vaccines. ROFO-FORTSCHR RONTG 2024. [PMID: 38906159 DOI: 10.1055/a-2328-7536] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/23/2024]
Abstract
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. Fortschr Röntgenstr 2024; DOI 10.1055/a-2328-7536.
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Affiliation(s)
- Caroline Wilpert
- Department of Diagnostic and Interventional Radiology, University Medical Center Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - Evelyn Wenkel
- Radiology, Radiologie München, Munich, Germany
- Medical Faculty, Friedrich-Alexander-Universität Erlangen-Nürnberg, Erlangen, Germany
| | - Pascal Andreas Thomas Baltzer
- Unit of General Radiology and Paediatric Radiology, Department of Biomedical Imaging and Image-guided Therapy, Medical University of Vienna, Vienna, Austria
| | | | - Heike Preibsch
- Diagnostic and Interventional Radiology, University Hospital Tuebingen, Tuebingen, Germany
| | - Stephanie Tina Sauer
- Department of Diagnostic and Interventional Radiology, University Hospital Wuerzburg, Wuerzburg, Germany
| | | | - Stefanie Weigel
- Department of Clinical Radiology and Reference Center for Mammography, University Hospital Muenster, Muenster, Germany
| | | | - Daniel Wessling
- Department of Diagnostic and Interventional Neuroradiology, University Hospital Heidelberg, Heidelberg, Germany
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Lamb LR, Mercaldo SF, Carney A, Leyva A, D'Alessandro HA, Lehman CD. Incidence, Timing, and Long-Term Outcomes of COVID-19 Vaccine-Related Lymphadenopathy on Screening Mammography. J Am Coll Radiol 2024:S1546-1440(24)00276-X. [PMID: 38461917 DOI: 10.1016/j.jacr.2024.02.032] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2023] [Revised: 01/29/2024] [Accepted: 02/09/2024] [Indexed: 03/12/2024]
Abstract
OBJECTIVE To determine the incidence, timing, and long-term outcomes of unilateral axillary lymphadenopathy ipsilateral to vaccine site (UIAL) on screening mammography after COVID-19 vaccination. METHODS This retrospective, multisite study included consecutive patients undergoing screening mammography February 8, 2021, to January 31, 2022, with at least 1 year of follow-up. UIAL was typically considered benign (BI-RADS 1 or 2) in the setting of recent (≤6 weeks) vaccination or BI-RADS 0 (ultrasound recommended) when accompanied by a breast finding or identified >6 weeks postvaccination. Vaccination status and manufacturer were obtained from regional registries. Lymphadenopathy rates in vaccinated patients with and without UIAL were compared using Pearson's χ2 test. RESULTS There were 44,473 female patients (mean age 60.4 ± 11.4 years) who underwent screening mammography at five sites, and 40,029 (90.0%) received at least one vaccine dose. Ninety-four (0.2%) presented with UIAL, 1 to 191 days postvaccination (median 13.5 [interquartile range: 5.0-31.0]). Incidence declined from 2.1% to 0.9% to ≤0.5% after 1, 2, and 3 weeks and persisted up to 36 weeks (P < .001). UIAL did not vary across manufacturer (P = .15). Of 94, 77 (81.9%) were BI-RADS 1 or 2 at screening. None were diagnosed with malignancy at 1-year follow-up. Seventeen (18.1%) were BI-RADS 0 at screening. At diagnostic workup, 13 (76.5%) were BI-RADS 1 or 2, 2 (11.8%) were BI-RADS 3, and 2 (11.8%) were BI-RADS 4. Both BI-RADS 4 patients had malignant status and ipsilateral breast malignancies. Of BI-RADS 3 patients, at follow-up, one was biopsied yielding benign etiology, and one was downgraded to BI-RADS 2. DISCUSSION Isolated UIAL on screening mammography performed within 6 months of COVID-19 vaccination can be safely assessed as benign.
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Affiliation(s)
- Leslie R Lamb
- Co-Director of Breast Imaging Research Center, Department of Radiology, Massachusetts General Hospital, Boston, Massachusetts.
| | - Sarah F Mercaldo
- Department of Radiology, Massachusetts General Hospital, Boston, Massachusetts
| | - Andrew Carney
- Department of Radiology, Massachusetts General Hospital, Boston, Massachusetts
| | - Alexander Leyva
- Department of Radiology, Massachusetts General Hospital, Boston, Massachusetts
| | | | - Constance D Lehman
- Department of Radiology, Massachusetts General Hospital, Boston, Massachusetts; Founder & Co-Director of Breast Imaging Research Center at Massachusetts General Hospital and Co-Founder of Clairity, Inc
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Eshet Y, Eifer M, Domachevsky L, Tau N. Hypermetabolic Axillary Lymphadenopathy After Shingrix Vaccination for Varicella Zoster Virus. Clin Nucl Med 2024; 49:e127-e128. [PMID: 38271246 DOI: 10.1097/rlu.0000000000005039] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/27/2024]
Abstract
ABSTRACT A 67-year-old woman underwent staging 18 F-FDG PET/CT scan for recently diagnosed breast cancer. Her scan showed a highly hypermetabolic right breast mass, with ipsilateral hypermetabolic axillary lymph nodes. The contralateral axillary lymph nodes were also enlarged with avid FDG uptake, alongside focal increased uptake in the left deltoid muscle. Upon investigation, the patient reported receiving the new zoster recombinant adjuvanted varicella zoster vaccine (Shingrix, GlaxoSmithKline) 4 days before the scan. The lymph node uptake could be potential pitfall for cancer staging.
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Nazerani-Zemann T, Pernthaler B, Schwantzer G, Gstettner C. The systemic impact of different COVID-19 vaccines in 2-[18F] FDG-PET/CT. Sci Rep 2023; 13:21838. [PMID: 38071353 PMCID: PMC10710488 DOI: 10.1038/s41598-023-49376-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2022] [Accepted: 12/07/2023] [Indexed: 12/18/2023] Open
Abstract
Austria started its COVID-19-vaccination program in December 2020 with three different vaccines. As the vaccination program continues, we encountered increased 2-[18F] FDG-activity not only in axillary lymph nodes ipsilateral to the injection site but also in other organs. The aim of this retrospective study is to present results of the metabolic activity of ipsilateral axillary lymph nodes, liver, blood pool, spleen, and bone marrow after three different vaccines. To our knowledge, this is the first study to examine systemic response changes in relation to time after COVID-19 vaccination using three different vaccines. The collected data of 220 eligible vaccinated patients (127 with BioNTech/Pfizer BNT162b2, 61 with Moderna, and 32 with AstraZeneca) examined with 2-[18F] FDG-PET/CT were enrolled. The PET/CT examinations were evaluated from day 1 to day 135 (SD: 23.2, median: 26) after different vaccinations. Seventy-one out of these 220 patients underwent a pre-vaccination 2-[18F] FDG -PET/CT. SUVmax of axillary node(s), and blood pool, liver, spleen, and bone marrow as reference organs were calculated. The ratio of SUVmax activity of axillary lymph node to reference organs was also compared in all patients. The tracer activity dynamics were investigated in three different vaccines. After BioNTech/Pfizer vaccination 2-[18F] FDG activity in axillary lymph nodes shows a steady decrease in all patients. Ten days after vaccination the 2-[18F] FDG uptake was at its highest activity. Seventy days after vaccination, tracer activity is not different from the background activity of 2-[18F] FDG in the axillary region. This result also applies to other two vaccines; however, in the 4th week after Moderna vaccination SUVmax in lymph nodes showed the highest peak of tracer activity. With AstraZeneca the highest activity was at the earlier days. There was no significant statistical difference of SUVmax of lymph nodes or its ratios to other reference organs between three groups of vaccines. SUVmax in lymph nodes was statistically significant lower than SUVmax in the liver, spleen, and bone marrow with p-values of < 0.001, 0.044, and 0.001, respectively. In the group of 71 patients with a pre-vaccination PET/CT examination, the median SUVmax of lymph nodes increased significantly after vaccination from 0.82 (IQR 0.59-1.38) to 1.80 (IQR 1.07-3.89)(p < 0.001). In contrast median tracer activity in the liver decreased from 3.37 (IQR 2.83-3.91) to 3.11 (2.56-3.70) (p = 0.032). There was no significant change of tracer activity after vaccination in other reference regions (mediastinum, spleen, and bone marrow). In this group of 71 patients, there was also no significant difference in tracer activity in different types of vaccines. Local site and ipsilateral axillary lymph node activity in 2-[18F] FDG PET/CT after COVID19-vaccination is suggested in many studies. The main challenge is recognizing the changes in lymph nodes during time after vaccination to minimize false interpretation, foremost in patients with oncological diagnoses. Moreover, different vaccines cause different system metabolic changes. The knowledge of vaccine type, the time interval between vaccination and PET/CT scan is essential, especially in therapy evaluation.
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Affiliation(s)
- Tina Nazerani-Zemann
- Division of Nuclear Medicine, Department of Radiology, Medical University of Graz, Auenbruggerplatz 9A, 8038, Graz, Austria.
| | - Birgit Pernthaler
- Division of Nuclear Medicine, Department of Radiology, Medical University of Graz, Auenbruggerplatz 9A, 8038, Graz, Austria
| | - Gerold Schwantzer
- Institute for Medical Informatics, Statistics and Documentation, Medical University of Graz, Graz, Austria
| | - Christian Gstettner
- Division of Nuclear Medicine, Department of Radiology, Medical University of Graz, Auenbruggerplatz 9A, 8038, Graz, Austria
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Igual-Rouilleault AC, Soriano I, Quan PL, Reina G, Del Pozo JL, Gónzalez Á, Fernández-Ciriza L, Fernández-Montero A, Pina L, Elizalde A. Prediction of effective humoral response to SARS-CoV-2 vaccines in healthy subjects by cortical thickness of post-vaccination reactive lymphadenopathy. Eur Radiol 2023; 33:7178-7185. [PMID: 37142867 PMCID: PMC10159827 DOI: 10.1007/s00330-023-09662-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2023] [Revised: 02/28/2023] [Accepted: 03/03/2023] [Indexed: 05/06/2023]
Abstract
PURPOSE To study the association between ultrasound cortical thickness in reactive post-vaccination lymph nodes and the elicited humoral response and to evaluate the performance of cortical thickness as a predictor of vaccine effectiveness in patients with and without a previous history of COVID-19 infection. METHODS A total of 156 healthy volunteers were recruited and followed prospectively after receiving two COVID-19 vaccination doses using different protocols. Within a week after receiving the second dose, an axillary ultrasound of the ipsilateral vaccinated arm was performed, and serial post-vaccination serologic tests (PVST) were collected. Maximum cortical thickness was chosen as a nodal feature to analyze association with humoral immunity. Total antibodies quantified during consecutive PVST in previously-infected patients and in coronavirus-naïve volunteers were compared (Mann-Whitney U test). The association between hyperplastic-reactive lymph nodes and effective humoral response was studied (odds ratio). The performance of cortical thickness in detecting vaccination effectiveness was evaluated (area under the ROC curve). RESULTS Significantly higher values for total antibodies were observed in volunteers with a previous history of COVID-19 infection (p < 0.001). The odds ratio associating immunized coronavirus-naïve volunteers after 90 and 180 days of the second dose with a cortical thickness ≥ 3 mm was statistically significant (95% CI 1.52-6.97 and 95% CI 1.47-7.29, respectively). The best AUC result was obtained comparing antibody secretion of coronavirus-naïve volunteers at 180 days (0.738). CONCLUSIONS Ultrasound cortical thickness of reactive lymph nodes in coronavirus-naïve patients may reflect antibody production and a long-term effective humoral response elicited by vaccination. CLINICAL RELEVANCE STATEMENT In coronavirus-naïve patients, ultrasound cortical thickness of post-vaccination reactive lymphadenopathy shows a positive association with protective antibody titers against SARS-CoV-2, especially in the long term, providing new insights into previous publications. KEY POINTS • Hyperplastic lymphadenopathy was frequently observed after COVID-19 vaccination. • Ultrasound cortical thickness of reactive post-vaccine lymph nodes may reflect a long-term effective humoral response in coronavirus-naïve patients.
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Affiliation(s)
| | - Ignacio Soriano
- Department of Radiology, Clínica Universidad de Navarra, Avenida Pío XII 36, Pamplona, Spain
| | - Paola Leonor Quan
- Department of Allergy and Clinical Immunology, Clínica Universidad de Navarra, Avenida Pío XII 36, Pamplona, Spain
| | - Gabriel Reina
- Clinical Microbiology Unit, Clínica Universidad de Navarra, Avenida Pío XII 36, Pamplona, Spain.
| | - José Luis Del Pozo
- Infectious Diseases Division, Clínica Universidad de Navarra, Avenida Pío XII 36, Pamplona, Spain
- Department of Clinical Microbiology, Clínica Universidad de Navarra, Avenida Pío XII 36, Pamplona, Spain
| | - Álvaro Gónzalez
- Laboratory of Biochemistry, Clínica Universidad de Navarra, Avenida Pío XII 36, Pamplona, Spain
| | - Leire Fernández-Ciriza
- Clinical Microbiology Unit, Clínica Universidad de Navarra, Avenida Pío XII, 36, Pamplona, Spain
| | | | - Luis Pina
- Breast Imaging Unit, Department of Radiology, Clínica Universidad de Navarra, Avenida Pío XII, 36, Pamplona, Spain
| | - Arlette Elizalde
- Breast Imaging Unit, Department of Radiology, Clínica Universidad de Navarra, Avenida Pío XII, 36, Pamplona, Spain
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Sawant DA, Razmaria AA, Pandit-Taskar N. Prolonged generalized immune response on 18F-FDG PET/CT following COVID-19 vaccination. Radiol Case Rep 2023; 18:2552-2557. [PMID: 37250482 PMCID: PMC10202611 DOI: 10.1016/j.radcr.2023.04.046] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2023] [Revised: 04/23/2023] [Accepted: 04/27/2023] [Indexed: 05/31/2023] Open
Abstract
The Coronavirus disease 2019 (COVID-19) pandemic continues to be a major public health concern affecting millions of people globally. The COVID-19 vaccination has implications in medical assessment of cancer patients especially undergoing diagnostic imaging such as 18F-fluoro-deoxyglucose (FDG) positron emission tomography with computed tomography (PET/CT). The inflammatory changes following vaccination can cause false positive findings on imaging. We present a case of a patient with esophageal carcinoma who had 18F-FDG PET/CT scan, 8 weeks following booster dose of Moderna COVID-19 vaccination, which showed widespread FDG avid reactive lymph nodes and intense splenic uptake for prolonged duration of approximately 8 months (34 weeks) probably representing generalized immune response. It is important from radiological/nuclear medicine perspective to recognize imaging features of such rare effect of COVID-19 vaccination, which can pose a challenge in assessing 18F-FDG PET/CT scans in cancer patients. It has also opened new avenues for future research evaluating such COVID-19 vaccine-related prolonged systemic immunological response in cancer patients.
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Affiliation(s)
- Devendra A. Sawant
- Department of Radiology, Molecular Imaging and Therapy Service, Memorial Sloan Kettering Cancer Center, 1275 York Avenue, New York, NY 10065, USA
| | - Ali Aria Razmaria
- Department of Radiology, Molecular Imaging and Therapy Service, Memorial Sloan Kettering Cancer Center, 1275 York Avenue, New York, NY 10065, USA
| | - Neeta Pandit-Taskar
- Department of Radiology, Molecular Imaging and Therapy Service, Memorial Sloan Kettering Cancer Center, 1275 York Avenue, New York, NY 10065, USA
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CALABRIA FERDINANDO, BAGNATO ANTONIO, GUADAGNINO GIULIANA, TOTEDA MARIA, LANZILLOTTA ANTONIO, CARDEI STEFANIA, TAVOLARO ROSANNA, LEPORACE MARIO. COVID-19 vaccine related hypermetabolic lymph nodes on PET/CT: Implications of inflammatory findings in cancer imaging. Oncol Res 2023; 31:117-124. [PMID: 37304242 PMCID: PMC10207995 DOI: 10.32604/or.2023.027705] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2022] [Accepted: 02/20/2023] [Indexed: 06/13/2023] Open
Abstract
We observed several patients presenting 2-[18F]FDG uptake in the reactive axillary lymph node at PET/CT imaging, ipsilateral to the site of the COVID-19 vaccine injection. Analog finding was documented at [18F]Choline PET/CT. The aim of our study was to describe this source of false positive cases. All patients examined by PET/CT were included in the study. Data concerning patient anamnesis, laterality, and time interval from recent COVID-19 vaccination were recorded. SUVmax was measured in all lymph nodes expressing tracer uptake after vaccination. Among 712 PET/CT scans with 2-[18F]FDG, 104 were submitted to vaccination; 89/104 patients (85%) presented axillary and/or deltoid tracer uptake, related to recent COVID-19 vaccine administration (median from injection: 11 days). The mean SUVmax of these findings was 2.1 (range 1.6-3.3). Among 89 patients with false positive axillary uptake, 36 subjects had received chemotherapy due to lymph node metastases from somatic cancer or lymphomas, prior to the scan: 6/36 patients with lymph node metastases showed no response to therapy or progression disease. The mean SUVmax value of lymph nodal localizations of somatic cancers/lymphomas after chemotherapy was 7.8. Only 1/31 prostate cancer patients examined by [18F]Choline PET/CT showed post-vaccine axillary lymph node uptake. These findings were not recorded at PET/CT scans with [18F]-6-FDOPA, [68Ga]Ga-DOTATOC, and [18F]-fluoride. Following COVID-19 mass vaccination, a significant percentage of patients examined by 2-[18F]FDG PET/CT presents axillary, reactive lymph node uptake. Anamnesis, low-dose CT, and ultrasonography facilitated correct diagnosis. Semi-quantitative assessment supported the visual analysis of PET/CT data; SUVmax values of metastatic lymph nodes were considerably higher than post-vaccine lymph nodes. [18F]Choline uptake in reactive lymph node after vaccination was confirmed. After the COVID-19 pandemic, nuclear physicians need to take these potential false positive cases into account in daily clinical practice.
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Affiliation(s)
- FERDINANDO CALABRIA
- Department of Nuclear Medicine and Theragnostics, Mariano Santo Hospital, Cosenza, 87100, Italy
| | - ANTONIO BAGNATO
- Department of Nuclear Medicine and Theragnostics, Mariano Santo Hospital, Cosenza, 87100, Italy
| | - GIULIANA GUADAGNINO
- Department of Infectious and Tropical Diseases, St. Annunziata Hospital, Cosenza, 87100, Italy
| | - MARIA TOTEDA
- Department of Nuclear Medicine and Theragnostics, Mariano Santo Hospital, Cosenza, 87100, Italy
| | - ANTONIO LANZILLOTTA
- Department of Nuclear Medicine and Theragnostics, Mariano Santo Hospital, Cosenza, 87100, Italy
| | - STEFANIA CARDEI
- Department of Nuclear Medicine and Theragnostics, Mariano Santo Hospital, Cosenza, 87100, Italy
| | - ROSANNA TAVOLARO
- Department of Nuclear Medicine and Theragnostics, Mariano Santo Hospital, Cosenza, 87100, Italy
| | - MARIO LEPORACE
- Department of Nuclear Medicine and Theragnostics, Mariano Santo Hospital, Cosenza, 87100, Italy
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Ahn RW, Porembka JH, Mootz AR, Goudreau SH, Dogan BE, Xi Y, Seiler SJ. Imaging of COVID-19 Vaccine-Related Axillary Lymphadenopathy: Initial Outcomes Based on US Features of Axillary Lymph Nodes. JOURNAL OF BREAST IMAGING 2023; 5:135-147. [PMID: 38416930 DOI: 10.1093/jbi/wbac091] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2022] [Indexed: 03/01/2024]
Abstract
OBJECTIVE The purpose of this study is to describe the imaging characteristics and outcomes of COVID-19 vaccine-related axillary adenopathy and subsequent follow-up. METHODS This was an IRB-approved, retrospective study of patients with imaging evidence of axillary lymphadenopathy who had received at least one dose of a COVID-19 vaccine and presented between January 1, 2021, and February 28, 2021. Sonographic cortical thickness and morphology was evaluated. A mixed effects model was used to model lymph node cortical thickness decrease over time. RESULTS A total of 57 women were identified with lymphadenopathy and a COVID vaccination during the study period with 51 (89.5%) women completing imaging surveillance or undergoing tissue sampling of a lymph node. Three women (5.9%) were diagnosed with metastatic breast cancer to an axillary node. There was a statistically significant correlation with cortical thickness at initial US evaluation and malignancy (7.7 mm [SD ± 0.6 mm] for metastatic nodes and 5 mm [SD ± 2 mm] for benign nodes, P = 0.02). Suspicious morphological features (effacement of fatty hilum, P = 0.02) also correlated with malignancy. Time to resolution of lymphadenopathy can be prolonged with estimated half-life of the rate of decrease in cortical thickness modeled at 77 days (95% CI, 59-112 days). Diffuse, smooth cortical thickening over 3 mm was the most common lymph node morphology. CONCLUSION Malignant lymph node morphology and cortical thickness best predicted malignancy. Benign hyperplastic lymph nodes were the most common morphology observed after COVID-19 vaccination. Lymphadenopathy after vaccination is slow to resolve.
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Affiliation(s)
- Richard W Ahn
- The University of Texas Southwestern Medical Center, Department of Radiology, Dallas, TX, USA
| | - Jessica H Porembka
- The University of Texas Southwestern Medical Center, Department of Radiology, Dallas, TX, USA
| | - Ann R Mootz
- The University of Texas Southwestern Medical Center, Department of Radiology, Dallas, TX, USA
| | - Sally H Goudreau
- The University of Texas Southwestern Medical Center, Department of Radiology, Dallas, TX, USA
| | - Basak E Dogan
- The University of Texas Southwestern Medical Center, Department of Radiology, Dallas, TX, USA
| | - Yin Xi
- The University of Texas Southwestern Medical Center, Department of Radiology, Dallas, TX, USA
| | - Stephen J Seiler
- The University of Texas Southwestern Medical Center, Department of Radiology, Dallas, TX, USA
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Madi S, Xie F, Farhangi K, Hsu CY, Cheng SH, Aweda T, Radaram B, Slania S, Lambert T, Rambo M, Skedzielewski T, Cole A, Sherina V, McKearnan S, Tran H, Alsaid H, Doan M, Stokes AH, O’Hagan DT, Maruggi G, Bertholet S, Temmerman ST, Johnson R, Jucker BM. MRI/PET multimodal imaging of the innate immune response in skeletal muscle and draining lymph node post vaccination in rats. Front Immunol 2023; 13:1081156. [PMID: 36713458 PMCID: PMC9874296 DOI: 10.3389/fimmu.2022.1081156] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2022] [Accepted: 12/23/2022] [Indexed: 01/13/2023] Open
Abstract
The goal of this study was to utilize a multimodal magnetic resonance imaging (MRI) and positron emission tomography (PET) imaging approach to assess the local innate immune response in skeletal muscle and draining lymph node following vaccination in rats using two different vaccine platforms (AS01 adjuvanted protein and lipid nanoparticle (LNP) encapsulated Self-Amplifying mRNA (SAM)). MRI and 18FDG PET imaging were performed temporally at baseline, 4, 24, 48, and 72 hr post Prime and Prime-Boost vaccination in hindlimb with Cytomegalovirus (CMV) gB and pentamer proteins formulated with AS01, LNP encapsulated CMV gB protein-encoding SAM (CMV SAM), AS01 or with LNP carrier controls. Both CMV AS01 and CMV SAM resulted in a rapid MRI and PET signal enhancement in hindlimb muscles and draining popliteal lymph node reflecting innate and possibly adaptive immune response. MRI signal enhancement and total 18FDG uptake observed in the hindlimb was greater in the CMV SAM vs CMV AS01 group (↑2.3 - 4.3-fold in AUC) and the MRI signal enhancement peak and duration were temporally shifted right in the CMV SAM group following both Prime and Prime-Boost administration. While cytokine profiles were similar among groups, there was good temporal correlation only between IL-6, IL-13, and MRI/PET endpoints. Imaging mass cytometry was performed on lymph node sections at 72 hr post Prime and Prime-Boost vaccination to characterize the innate and adaptive immune cell signatures. Cell proximity analysis indicated that each follicular dendritic cell interacted with more follicular B cells in the CMV AS01 than in the CMV SAM group, supporting the stronger humoral immune response observed in the CMV AS01 group. A strong correlation between lymph node MRI T2 value and nearest-neighbor analysis of follicular dendritic cell and follicular B cells was observed (r=0.808, P<0.01). These data suggest that spatiotemporal imaging data together with AI/ML approaches may help establish whether in vivo imaging biomarkers can predict local and systemic immune responses following vaccination.
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Affiliation(s)
| | - Fang Xie
- Bioimaging, GSK, Collegeville, PA, United States
| | | | | | | | | | | | | | - Tammy Lambert
- Non Clinical Safety, GSK, Collegeville, PA, United States
| | - Mary Rambo
- Bioimaging, GSK, Collegeville, PA, United States
| | | | - Austin Cole
- Research Statistics, GSK, Collegeville, PA, United States
| | | | | | - Hoang Tran
- Research Statistics, GSK, Collegeville, PA, United States
| | - Hasan Alsaid
- Bioimaging, GSK, Collegeville, PA, United States
| | - Minh Doan
- Bioimaging, GSK, Collegeville, PA, United States
| | - Alan H. Stokes
- Non Clinical Safety, GSK, Collegeville, PA, United States
| | - Derek T. O’Hagan
- Vaccines Research & Development, GSK, Rockville, MD, United States
| | | | - Sylvie Bertholet
- Vaccines Research & Development, GSK, Rockville, MD, United States
| | | | - Russell Johnson
- Vaccines Research & Development, GSK, Rockville, MD, United States
| | - Beat M. Jucker
- Clinical Imaging, GSK, Collegeville, PA, United States,*Correspondence: Beat M. Jucker,
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10
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FDG-PET findings associated with various medical procedures and treatments. Jpn J Radiol 2022; 41:459-476. [PMID: 36575286 PMCID: PMC9794480 DOI: 10.1007/s11604-022-01376-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2022] [Accepted: 12/12/2022] [Indexed: 12/29/2022]
Abstract
[18F]-fluorodeoxyglucose (FDG) positron emission tomography (PET) is a well-established modality with high sensitivity for the diagnosis and staging of oncologic patients. FDG is taken up by the glucose transporter of the cell membrane and becomes trapped within the cell. In addition to malignant neoplasms, active inflammatory lesions and some kinds of benign tumors also accumulate FDG. Moreover, the degree of uptake into normal organs and tissues depends on various physiological conditions, which is affected by various medical procedures, treatments, and drugs. To avoid misleading interpretations, it is important to recognize possible situations of unexpected abnormal accumulation that mimic tumor lesions. In this review, we present various FDG findings associated with surgical or medical procedures and treatments. Some findings reflect the expected physiological reaction to treatment, and some show inflammation due to prior procedures. Occasionally, FDG-PET visualizes other disorders that are unrelated to the malignancy, which may be associated with the adverse effects of certain drugs that the patient is taking. Careful review of medical records and detailed interviews of patients are thus necessary.
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Soeder E, Toro-Pape FW, Lampen-Sachar K. Isolated breast parenchymal changes following COVID-19 vaccine booster. Radiol Case Rep 2022; 17:4556-4560. [PMID: 36176967 PMCID: PMC9513531 DOI: 10.1016/j.radcr.2022.08.094] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2022] [Accepted: 08/25/2022] [Indexed: 10/28/2022] Open
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Minamimoto R. Oncology and cardiology positron emission tomography/computed tomography faced with COVID-19: A review of available literature data. Front Med (Lausanne) 2022; 9:1052921. [DOI: 10.3389/fmed.2022.1052921] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/24/2022] [Accepted: 10/07/2022] [Indexed: 01/18/2023] Open
Abstract
The COVID-19 pandemic has forced people to significantly change their lifestyles and attitudes, and has greatly burdened healthcare delivery systems worldwide. The redistribution of the medical delivery system to maintain normal medical care while responding generously to COVID-19 is a continuing challenge that weighs heavily on medical institutions. Among imaging modalities, chest X-rays and computed tomography (CT) examinations have clearly made a large contribution to treatment of COVID-19. In contrast, it is difficult to express the standpoint of nuclear medicine examinations in a straightforward manner, as the greatest emphasis in this modality has been on how necessary medical care can continue to be provided. Many clinical reports of nuclear medicine examinations related to COVID-19 have been published, and knowledge continues to accumulate. This review provides a summary of the current state of oncology and cardiology positron emission tomography (PET) examinations related to COVID-19, and includes preparation of the nuclear medicine department, trends in PET examinations, specific imaging findings on 18F-fluorodeoxyglucose (FDG) PET/CT, imaging of complications of COVID-19, PET tracers other than FDG, and the effects of vaccines on PET imaging findings.
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13
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Igual-Rouilleault AC, Soriano I, Elizalde A, Quan PL, Fernandez-Montero A, Sobrido C, Pina L. Axillary lymph node imaging in mRNA, vector-based, and mix-and-match COVID-19 vaccine recipients: ultrasound features. Eur Radiol 2022; 32:6598-6607. [PMID: 35554651 PMCID: PMC9098792 DOI: 10.1007/s00330-022-08846-9] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2022] [Revised: 04/21/2022] [Accepted: 04/25/2022] [Indexed: 02/01/2023]
Abstract
OBJECTIVES To assess ultrasound characteristics of ipsilateral axillary lymph nodes after two doses of four different COVID-19 vaccination protocols, to determine whether these parameters differed with age, and to describe how they changed on follow-up imaging. METHODS A total of 247 volunteer employees from our center who had received two doses of COVID-19 vaccination were recruited and followed prospectively. Axillary ultrasound of the ipsilateral vaccinated arm was performed the week after receiving the second dose to analyze lymph node features (number, long-axis, cortical thickness, morphology, and vascular imaging). Axillary lymphadenopathy resulting from four vaccination protocols-mRNA (BNT162b2, mRNA-1273), ChAdOx1-S, and mix-and-match-was compared. Analysis was conducted using the Kruskal-Wallis test and post hoc analysis with Bonferroni corrections. Nodal reactogenicity was evaluated for two age groups: young (< 45 years old) and middle-aged ( ≥ 45 years old). All parameters were compared between both groups using an unpaired-sample Student t test. A p value < 0.05 was considered statistically significant. RESULTS Significantly higher values for total number of visible nodes, cortical thickness, Bedi's classification (p < 0.001), and vascularity (p < 0.05) were observed in mRNA vaccine recipients compared to full ChAdOx1-S protocol recipients. Moreover, mix-and-match protocol recipients showed greater nodal cortical thickness and higher Bedi's classification than full ChAdOx1-S recipients (p < 0.001). Analyses between age groups revealed greater cortical thickness, Bedi's classification, and color Doppler signal in younger patients (p < 0.05). CONCLUSIONS Nodal parameters of Bedi's classification and cortical thickness were more often increased in mRNA and mix-and-match vaccine recipients when compared to ChAdOx1-S vaccine alone, especially in younger patients. KEY POINTS • Hyperplastic lymphadenopathy was observed more frequently in mRNA and mix-and-match vaccine protocols compared to full vector-based vaccination. • Higher values for cortical thickness, Bedi's classification, and color Doppler signal parameters were identified in younger patients. • Observed lymph node findings normalized in greater than 80% of patients by the third month following vaccination.
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Affiliation(s)
| | - Ignacio Soriano
- Department of Radiology, Clínica Universidad de Navarra, Avenida Pío XII, 36, 31008, Pamplona, Spain
| | - Arlette Elizalde
- Breast Imaging Unit, Department of Radiology, Clínica Universidad de Navarra, Avenida Pío XII, 36, Pamplona, Spain
| | - Paola Leonor Quan
- Department of Allergy and Clinical Immunology, Clínica Universidad de Navarra, Avenida Pío XII, 36, Pamplona, Spain
| | | | - Carolina Sobrido
- Breast Imaging Unit, Department of Radiology, Clínica Universidad de Navarra, C. Marquesado de Sta. Marta, 1, Madrid, Spain
| | - Luis Pina
- Breast Imaging Unit, Department of Radiology, Clínica Universidad de Navarra, Avenida Pío XII, 36, Pamplona, Spain
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ÇEVİK B. Association of COVID-19 vaccine with lymph node reactivity: an ultrasound-based study. JOURNAL OF HEALTH SCIENCES AND MEDICINE 2022. [DOI: 10.32322/jhsm.1123597] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
Aim: Millions of people worldwide have been infected and died due to the pandemic caused by COVID-19. Vaccination is the most effective way to deal with the pandemic. Though vaccines are safe, they are not completely risk-free, and some side effects can occur after vaccination such as lymphadenopathy. This study, it was aimed to measure the lymph node reactivity that may develop after mRNA vaccination.
Material and Method: A total of 50 healthy people were included in the study. Left axillary and supraclavicular ultrasound examinations were performed before and one week after the administration of the mRNA vaccine. Each patient was assessed for supraclavicular and level 1 axillary lymph region in terms of the presence, size (long and short axis), and cortex thickness of the lymph nodes.
Results: Of the patients participating in the study, 23 (46 %) were male, 27 (54 %) were female, and the median age was 33. In comparison, the difference in long, short axis and cortex diameter measurements of the supraclavicular lymph node before and after vaccination was found to be statistically significant (p=0.034, 0.021, 0.004, respectively). Similarly, the difference in the long, short axis, and cortex thickness of the left axillary lymph node before and after vaccination was statistically significant (p<0.001, <0.001, <0.001, respectively).
Conclusion: Anti-Covid-19 vaccines may cause lymphadenopathy as a result of reactivation in lymph nodes in the left axillary and supraclavicular regions. When lymphadenopathy is detected in these regions, the vaccine should be questioned in the clinical history and ultrasound follow-up should be performed on the patient.
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Gales LN, Brotea-Mosoiu S, Trifanescu OG, Lazar AM, Gherghe M. Understanding COVID Vaccination and Its Implication in Cancer Patients’ Imaging of Lymph Nodes by PET-CT. Diagnostics (Basel) 2022; 12:diagnostics12092163. [PMID: 36140564 PMCID: PMC9497665 DOI: 10.3390/diagnostics12092163] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2022] [Revised: 08/11/2022] [Accepted: 09/01/2022] [Indexed: 11/24/2022] Open
Abstract
(1) Background: The appearance of enlarged lymph nodes on imaging adds another layer of complexity to the differential diagnosis of disease progression versus immune response to COVID-19 vaccines. Our aim was to find an optimal timing between the vaccination and the PET-CT scan. (2) Methods: 25 cancer patients with 18F-FDG PET-CT evaluations and a history of COVID-19 vaccination between September 2021 and December 2021 were retrospectively analyzed to characterize the lymph nodes related to the time interval from COVID vaccination. (3) Results: All patients presented one or more adenopathies localized in the ipsilateral axilla (96%), ipsilateral cervical area (20%), ipsilateral retropectoral (20%) and pulmonary hilum (8%). The median value of SUVmax was 3.5 ± 0.5. There was a significant indirect correlation between SUVmax and the time passed between the vaccination and the PET CT (Pearson Correlation r = −0.54, p = 0.005). There was no significant difference (p = 0.19) in the SUVmax value in patients receiving Moderna mRNA-1273 vaccine vs. BNT162b2 mRNA Pfizer vaccine. (4) Conclusions: Lymph node enlargement is commonly seen in patients post-vaccination for COVID-19 and must be differentiated from disease progression. The data from our study strongly suggests that the minimum interval of time between an mRNA vaccine and a PET-CT should be more than six weeks.
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Affiliation(s)
- Laurentia Nicoleta Gales
- Oncology Department, Institute of Oncology “Prof. Dr. Alexandru Trestioreanu”, 022328 Bucharest, Romania
- Oncology Department, University of Medicine and Pharmacy “Carol Davila” Bucharest, 050474 Bucharest, Romania
| | - Silvia Brotea-Mosoiu
- Oncology Department, Institute of Oncology “Prof. Dr. Alexandru Trestioreanu”, 022328 Bucharest, Romania
- Oncology Department, University of Medicine and Pharmacy “Carol Davila” Bucharest, 050474 Bucharest, Romania
- Correspondence:
| | - Oana Gabriela Trifanescu
- Oncology Department, Institute of Oncology “Prof. Dr. Alexandru Trestioreanu”, 022328 Bucharest, Romania
- Oncology Department, University of Medicine and Pharmacy “Carol Davila” Bucharest, 050474 Bucharest, Romania
| | - Alexandra Maria Lazar
- Nuclear Medicine Department, Institute of Oncology “Prof. Dr. Alexandru Trestioreanu”, 022328 Bucharest, Romania
| | - Mirela Gherghe
- Nuclear Medicine Department, Institute of Oncology “Prof. Dr. Alexandru Trestioreanu”, 022328 Bucharest, Romania
- Nuclear Medicine Department, University of Medicine and Pharmacy “Carol Davila” Bucharest, 050474 Bucharest, Romania
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Andresciani F, Ricci M, Grasso RF, Zobel BB, Quattrocchi CC. COVID-19 vaccination simulating lymph node progression in a patient with prostate cancer. Radiol Case Rep 2022; 17:2996-2999. [PMID: 35747740 PMCID: PMC9212885 DOI: 10.1016/j.radcr.2022.05.072] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2022] [Revised: 05/23/2022] [Accepted: 05/26/2022] [Indexed: 11/18/2022] Open
Abstract
Several cases of cancer patients with 18-fluorodeoxyglucose (18FDG) Positron Emission Tomography/Computed Tomography (PET/CT) evidence of metabolically active axillary lymph nodes after COVID-19 vaccination have been described, creating a diagnostic dilemma and sometimes leading to further unnecessary examinations. A 62-year-old male, diagnosed with prostate cancer, treated with hormone-therapy and radiotherapy of the prostate 2 years before, underwent fluorine-18 choline (F-FCH) PET/CT for restaging purpose, less than 3 weeks after he had received the second dose of the Pfizer BioNTech-BNT162b2 mRNA COVID-19 vaccine. This exam showed an increased F-FCH uptake and an enlargement of the left axillary, paratracheal, para-aortic, subcarinal, and hilar bilateral lymph nodes. Fourteen weeks later, the patient underwent a new F-FCH PET-CT scan, displaying an almost complete regularization of the FCH uptake in all the previously involved regions. The patient was not treated after the first PET-CT scan, thus, the aforementioned PET/CT findings represented inflammatory vaccine-related lymph nodes. This case highlights the significance of knowing vaccination history to correctly interpret imaging findings and to avoid false-positive reports.
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17
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Kirienko M, Biroli M, Pini C, Gelardi F, Sollini M, Chiti A. COVID-19 vaccination, implications for PET/CT image interpretation and future perspectives. Clin Transl Imaging 2022; 10:631-642. [PMID: 35992042 PMCID: PMC9379874 DOI: 10.1007/s40336-022-00521-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2022] [Accepted: 07/28/2022] [Indexed: 11/25/2022]
Abstract
Introduction The present paper aims to systematically review the literature on COVID-19 vaccine-related findings in patients undergoing PET/CT. Methods The search algorithms included the following combination of terms: “PET” OR “positron emission tomography” AND “COVID”; “PET” OR “positron emission tomography” AND “COVID” AND “vaccination”; “PET” OR “positron emission tomography” AND “COVID”, AND “autoimmune”. Results We selected 17 articles which were assessed for quality and included in the systematic analysis. The most frequent vaccine-related signs on PET/CT were the deltoid [18F]FDG uptake and axillary hypermetabolic lymph nodes, which were described in 8–71% and 7–90% of the patients, respectively. Similarly, frequency of these findings using other tracers than [18F]FDG was greatly variable. This large variability was related to the variability in time elapsed between vaccination and PET/CT, and the criteria used to define positivity. In addition, vaccine-related findings were detected more frequently in young and immunocompetent patients than in elderly and immunocompromised ones. Discussion Therefore, awareness on vaccination status (timing, patient characteristics, and concurrent therapies) and knowledge on patterns of radiopharmaceutical uptake are necessary to properly interpret PET/CT findings.
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Affiliation(s)
- Margarita Kirienko
- Fondazione IRCCS Istituto Nazionale Tumori, Via G. Venezian 1, 20133 Milan, Italy
| | - Matteo Biroli
- Department of Biomedical Sciences, Humanitas University, Via Rita Levi Montalcini 4, Pieve Emanuele, 20090 Milan, Italy
| | - Cristiano Pini
- Department of Biomedical Sciences, Humanitas University, Via Rita Levi Montalcini 4, Pieve Emanuele, 20090 Milan, Italy
- IRCCS Humanitas Research Hospital, Via Manzoni 56, Rozzano, 20089 Milan, Italy
| | - Fabrizia Gelardi
- Department of Biomedical Sciences, Humanitas University, Via Rita Levi Montalcini 4, Pieve Emanuele, 20090 Milan, Italy
- IRCCS Humanitas Research Hospital, Via Manzoni 56, Rozzano, 20089 Milan, Italy
| | - Martina Sollini
- Department of Biomedical Sciences, Humanitas University, Via Rita Levi Montalcini 4, Pieve Emanuele, 20090 Milan, Italy
- IRCCS Humanitas Research Hospital, Via Manzoni 56, Rozzano, 20089 Milan, Italy
| | - Arturo Chiti
- Department of Biomedical Sciences, Humanitas University, Via Rita Levi Montalcini 4, Pieve Emanuele, 20090 Milan, Italy
- IRCCS Humanitas Research Hospital, Via Manzoni 56, Rozzano, 20089 Milan, Italy
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18
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Seban RD, Richard C, Nascimento-Leite C, Ghidaglia J, Provost C, Gonin J, Tourneau CL, Romano E, Deleval N, Champion L. Absolute Lymphocyte Count After COVID-19 Vaccination Is Associated with Vaccine-Induced Hypermetabolic Lymph Nodes on 18F-FDG PET/CT: A Focus in Breast Cancer Care. J Nucl Med 2022; 63:1231-1238. [PMID: 34857663 PMCID: PMC9364344 DOI: 10.2967/jnumed.121.263082] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/20/2021] [Accepted: 11/09/2021] [Indexed: 12/05/2022] Open
Abstract
We aimed to predict the presence of vaccine-induced hypermetabolic lymph nodes (v-HLNs) on 18F-FDG PET/CT after coronavirus disease 2019 (COVID-19) vaccination and determine their association with lymphocyte counts. Methods: In this retrospective single-center study, we included consecutive patients who underwent 18F-FDG PET/CT imaging after messenger RNA- or viral vector-based COVID-19 vaccination between early March and late April 2021. Demographics, clinical parameters, and absolute lymphocyte count (ALC) were collected, and their association with the presence of v-HLNs in the draining territory was studied by logistic regression. Results: In total, 260 patients were eligible, including 209 (80%) women and 145 (56%) with breast cancer. The median age was 50 y (range, 23-96 y). The messenger RNA vaccine had been given to 233 (90%). Ninety (35%) patients had v-HLNs, with a median SUVmax of 3.7 (range, 2.0-26.3), and 74 (44%) displayed lymphopenia, with a median ALC of 1.4 × 109/L (range, 0.3-18.3 × 109/L). An age of no more than 50 y (odds ratio [OR], 2.2; 95% CI, 1.0-4.5), the absence of lymphopenia (OR, 2.2; 95% CI, 1.1-4.3), and less than a 30-d interval from the last vaccine injection to the 18F-FDG PET/CT (OR, 2.6; 95% CI, 1.3-5.6) were independent factors for v-HLNs on multivariate analysis. In breast cancer patients, the absence of lymphopenia was the only independent factor significantly associated with v-HLNs (OR, 2.9; 95% CI, 1.2-7.4). Conclusion: Patients with a normal ALC after COVID-19 vaccination were more likely to have v-HLNs on 18F-FDG PET/CT, both of which might be associated with a stronger immune response to vaccination.
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Affiliation(s)
- Romain-David Seban
- Department of Nuclear Medicine and Endocrine Oncology, Institut Curie, Saint-Cloud, France;
- Laboratoire d'Imagerie Translationnelle en Oncologie, InsermU1288, PSL Research University, Institut Curie, Orsay, France
| | - Capucine Richard
- Department of Nuclear Medicine and Endocrine Oncology, Institut Curie, Saint-Cloud, France
| | | | - Jerome Ghidaglia
- Department of Nuclear Medicine and Endocrine Oncology, Institut Curie, Saint-Cloud, France
| | - Claire Provost
- Laboratoire d'Imagerie Translationnelle en Oncologie, InsermU1288, PSL Research University, Institut Curie, Orsay, France
- Department of Radio-Pharmacology, Institut Curie, Saint-Cloud, France
| | - Julie Gonin
- Department of Pathology, Institut Curie, Saint-Cloud, France
| | - Christophe Le Tourneau
- Department of Drug Development and Innovation (D3i), Institut Curie, Paris, France
- INSERM U900 Research team, Paris Saclay University, Saint-Cloud, France
| | - Emanuela Romano
- Department of Medical Oncology, Center for Cancer Immunotherapy, Institut Curie, Paris, France; and
- INSERM U932, PSL Research University, Institut Curie, Paris, France
| | - Nicolas Deleval
- Department of Nuclear Medicine and Endocrine Oncology, Institut Curie, Saint-Cloud, France
| | - Laurence Champion
- Department of Nuclear Medicine and Endocrine Oncology, Institut Curie, Saint-Cloud, France
- Laboratoire d'Imagerie Translationnelle en Oncologie, InsermU1288, PSL Research University, Institut Curie, Orsay, France
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Ah-Thiane L, Ferrer L, Maucherat B, Fleury V, Le Thiec M, Rusu D, Rousseau C. Vaccine-Related Lymph Nodes: The Emerging Pitfalls of 18F-Fluorocholine and 68Ga-PSMA-11 PET/CT in the Era of COVID-19 Vaccination. Clin Nucl Med 2022; 47:575-582. [PMID: 35675134 PMCID: PMC9169609 DOI: 10.1097/rlu.0000000000004190] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2021] [Revised: 02/14/2022] [Accepted: 02/14/2022] [Indexed: 11/27/2022]
Abstract
PURPOSE Vaccination against coronavirus disease 2019 (COVID-19) is currently under worldwide deployment. The consequences of this vaccination can be seen in radiology and nuclear medicine explorations with visualization of axillary lymph nodes (LNs), as observed on ultrasonography, MRI, or 18F-FDG PET/CT.We aimed to evaluate on PET/CT the incidence of vaccine-related LNs and their characteristics after COVID-19 vaccination, using several radiopharmaceuticals different from 18F-FDG. PATIENTS AND METHODS Between February and July 2021, all consecutive patients undergoing a whole-body PET/CT for any indication using a different radiopharmaceutical from 18F-FDG were eligible for inclusion if they had received at least 1 dose of the COVID-19 vaccine. The radiopharmaceutical administered and vaccine type were recorded for each patient. The incidence of positive vaccine-related axillary and supraclavicular LNs on PET/CT was our primary finding, along with the nodes characteristics. Statistical analyses were performed for patients with prostate cancer (PCa) to determine certain interaction factors that were associated with the detection of vaccine-related LNs. RESULTS Of the 226 patients in our cohort study, 120 patients underwent an 18F-fluorocholine PET/CT, 79 a 68Ga-PSMA-11 PET/CT, 6 an 18F-FDOPA PET/CT, and 21 a 68Ga-DOTATOC PET/CT. A total of 67.3% of patients (152/226) received BNT162b2mRNA (Pfizer-BioNTech), 26.5% (60/226) ChAdOx1-S (AstraZeneca), 4.9% (11/226) mRNA-1273 (Moderna), and 1.3% (3/226) Ad26.COV2.S (Janssen). The incidence of positive vaccine-related axillary and supraclavicular LNs was 42.5% (51/120 patients) on PET/CT using 18F-fluorocholine and 12.7% (10/79 patients) with 68Ga-PSMA-11. None of our patients undergoing 18F-FDOPA or 68Ga-DOTATOC PET/CT presented any vaccine-related lymphadenopathy. Vaccine-related LNs were statistically associated with the nature of the radiopharmaceutical (P < 10-4), with the number of vaccine doses received (P = 0.041), with a short delay between vaccination and PET/CT realization (P < 10-5), and with a higher prostate-specific antigen level for patients with PCa (P = 0.032), but not with age or vaccine type. The vaccine-related nodes appeared in 85% of the cases, in the 30 days after vaccine injection, were limited in size and uptake, and were most often limited to the axilla level 1 area. CONCLUSIONS Detecting positive LNs after COVID-19 vaccination is not an exclusive 18F-FDG PET/CT pattern but is common on 18F-fluorocholine and possible on 68Ga-PSMA-11 PET/CT. Confronting PET/CT findings with clinical data (such as date and site of injection) seems essential in the current pandemic context, just as it does for the radiopharmaceuticals used in PCa to avoid PET/CT misinterpretation and incorrect patient treatment. For 18F-FDOPA or 68Ga-DOTATOC PET/CT, this seems to have a lesser impact.
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Affiliation(s)
| | - Ludovic Ferrer
- From the ICO René Gauducheau, Saint-Herblain
- CRCI2NA, UMR 1307 Inserm - UMR 6075 CNRS, Nantes, France
| | | | | | | | | | - Caroline Rousseau
- From the ICO René Gauducheau, Saint-Herblain
- CRCI2NA, UMR 1307 Inserm - UMR 6075 CNRS, Nantes, France
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Alharbi NK, Al-Tawfiq JA, Alghnam S, Alwehaibe A, Alasmari A, Alsagaby SA, Alsubaie F, Alshomrani M, Farahat FM, Bosaeed M, Alharbi A, Aldibasi O, Assiri AM. Outcomes of single dose COVID-19 vaccines: Eight month follow-up of a large cohort in Saudi Arabia. J Infect Public Health 2022; 15:573-577. [PMID: 35472755 PMCID: PMC8986276 DOI: 10.1016/j.jiph.2022.04.001] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2021] [Revised: 03/10/2022] [Accepted: 04/03/2022] [Indexed: 12/24/2022] Open
Abstract
BACKGROUND Two vaccines for COVID-19 have been approved and administered in the Kingdom of Saudi Arabia (KSA); Pfizer-BioNtech BNT162b2 and AstraZeneca-Oxford AZD1222 vaccines. The purpose of this study was to describe the real-world data on the outcome of single dose of these COVID-19 vaccines in a large cohort in KSA and to analyse demographics and co-morbidities as risk factors for infection post one-dose vaccination. METHODS In this prospective cohort study, a total of 18,543 subjects received one dose of either of the vaccines at a vaccination centre in KSA, and were followed up for three to eight months. Data were collected from three sources; clinical data from medical records, adverse events (AEs) from a self-reporting system, and COVID-19 infection data from the national databases. The study was conducted during the pandemic restrictions on travel, mobility, and social interactions. RESULTS The median age of participants was 33 years with an average body mass index of 27.3. The majority were males (60.1%). Results showed that 92.17% of the subjects had no COVID-19 infection post-vaccination as infection post-vaccination was documented for 1452 (7.83%). Diabetes mellitus 03), organ transplantation (p = 0.02), and obesity (p < 0.01) were associated with infection post-vaccination. Unlike vaccine type, being Saudi, male, or obese was associated with the occurrence breakthrough infections more than other parameters. AEs included injection site pain, fatigue, fever, myalgia, headache and was reported by 5.8% of the subjects. CONCLUSION Single dose COVID-19 vaccines showed a protection rate of 92.17% up to eight months follow-up in this cohort. This rate in AZD1222 was higher than what have been previously reported in effectiveness studies and clinical trials. Obese, male, and Saudi were at higher risk of contracting the infection post-vaccination, Saudi and male might have more social interaction with the public when mobility and social interactions were limited during the pandemic. Side effects and AEs were within what has been reported in clinical trials.
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Affiliation(s)
- Naif Khalaf Alharbi
- King Abdullah International Medical Research Center (KAIMRC), Riyadh, Saudi Arabia; King Saud bin Abdulaziz University for Health Science (KSAU-HS), Riyadh, Saudi Arabia.
| | - Jaffar A Al-Tawfiq
- Specialty Internal Medicine and Quality Department, Johns Hopkins Aramco Healthcare, Dhahran, Saudi Arabia; Infectious Disease Division, Department of Medicine, Indiana University School of Medicine, Indianapolis, IN, USA; Infectious Disease Division, Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Suliman Alghnam
- King Abdullah International Medical Research Center (KAIMRC), Riyadh, Saudi Arabia; King Saud bin Abdulaziz University for Health Science (KSAU-HS), Riyadh, Saudi Arabia
| | - Amal Alwehaibe
- King Abdullah International Medical Research Center (KAIMRC), Riyadh, Saudi Arabia
| | - Abrar Alasmari
- Department of Infectious Disease Epidemiology, London School of Hygiene & Tropical Medicine, Keppel Street, London WC1E 7HT, UK
| | - Suliman A Alsagaby
- Department of Medical Laboratory Sciences, College of Applied Medical Sciences, Majmaah University, Al Majmaah 11952, Saudi Arabia
| | - Faisal Alsubaie
- Assistant Agency for Preventive Health, Ministry of Health, Riyadh, Saudi Arabia
| | - Majid Alshomrani
- King Saud bin Abdulaziz University for Health Science (KSAU-HS), Riyadh, Saudi Arabia; King Abdulaziz Medical City (KAMC), Ministry of National Guard - Health Affairs (MNG-HA), Riyadh, Saudi Arabia
| | - Fayssal M Farahat
- King Saud bin Abdulaziz University for Health Science (KSAU-HS), Riyadh, Saudi Arabia; King Abdulaziz Medical City (KAMC), Ministry of National Guard - Health Affairs (MNG-HA), Riyadh, Saudi Arabia
| | - Mohammad Bosaeed
- King Abdullah International Medical Research Center (KAIMRC), Riyadh, Saudi Arabia; King Saud bin Abdulaziz University for Health Science (KSAU-HS), Riyadh, Saudi Arabia; King Abdulaziz Medical City (KAMC), Ministry of National Guard - Health Affairs (MNG-HA), Riyadh, Saudi Arabia
| | - Ahmad Alharbi
- King Abdulaziz Medical City (KAMC), Ministry of National Guard - Health Affairs (MNG-HA), Riyadh, Saudi Arabia
| | - Omar Aldibasi
- King Abdullah International Medical Research Center (KAIMRC), Riyadh, Saudi Arabia; King Saud bin Abdulaziz University for Health Science (KSAU-HS), Riyadh, Saudi Arabia
| | - Abdullah M Assiri
- Assistant Agency for Preventive Health, Ministry of Health, Riyadh, Saudi Arabia
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21
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Moysi E, Paris RM, Le Grand R, Koup RA, Petrovas C. Human lymph node immune dynamics as driver of vaccine efficacy: an understudied aspect of immune responses. Expert Rev Vaccines 2022; 21:633-644. [PMID: 35193447 DOI: 10.1080/14760584.2022.2045198] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
INTRODUCTION During the last century, changes in hygiene, sanitation, and the advent of childhood vaccination have resulted in profound reductions in mortality from infectious diseases. Despite this success, infectious diseases remain an enigmatic public health threat, where effective vaccines for influenza, human immunodeficiency virus (HIV), tuberculosis, and malaria, among others remain elusive. AREA COVERED In addition to the immune evasion tactics employed by complex pathogens, our understanding of immunopathogenesis and the development of effective vaccines is also complexified by the inherent variability of human immune responses. Lymph nodes (LNs) are the anatomical sites where B cell responses develop. An important, but understudied component of immune response complexity is variation in LN immune dynamics and in particular variation in germinal center follicular helper T cells (Tfh) and B cells which can be impacted by genetic variation, aging, the microbiome and chronic infection. EXPERT OPINION This review describes the contribution of genetic variation, aging, microbiome and chronic infection on LN immune dynamics and associated Tfh responses and offers perspective on how inclusion of LN immune subset and cytoarchitecture analyses, along with peripheral blood biomarkers can supplement systems vaccinology or immunology approaches for the development of vaccines or other interventions to prevent infectious diseases.
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Affiliation(s)
- Eirini Moysi
- Tissue Analysis Core, Vaccine Research Center, NIAID, NIH, Bethesda, MD, USA
| | | | - Roger Le Grand
- Center for Immunology of Viral, Auto-immune, Hematological and Bacterial diseases (IMVA-HB/IDMIT), Université Paris-Saclay, Inserm, CEA, Fontenay-aux-Roses, France
| | - Richard A Koup
- Immunology Laboratory, Vaccine Research Center, NIAID, NIH, Bethesda, MD, USA
| | - Constantinos Petrovas
- Tissue Analysis Core, Vaccine Research Center, NIAID, NIH, Bethesda, MD, USA.,Department of Laboratory Medicine and Pathology, Institute of Pathology, Lausanne University Hospital (CHUV) and University of Lausanne, Lausanne, Switzerland
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22
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Abstract
BACKGROUND Pre-approval clinical trials of the Pfizer/BioNTech messenger RNA COVID-19 vaccine, BNT162b2 did not include participants who were breastfeeding. Therefore, there is limited evidence about outcomes of breastfeeding mother-child dyads and effects on breastfeeding after vaccination. RESEARCH AIMS To determine: (1) solicited adverse effects (e.g., axillary lymphadenopathy, mastitis, and breast engorgement), which are unique to lactating individuals; and (2) systemic and local adverse effects of COVID-19 mRNA vaccine on mothers and potential effects on their breastfed infants. METHOD This was a prospective cohort study of lactating healthcare workers (N = 88) in Singapore who received two doses of BNT162b2 vaccination (Pfizer/BioNTech). The outcomes of mother-child dyads within 28 days after the second vaccine dose were determined through a participant-completed questionnaire. RESULTS Minimal effects related to breastfeeding were reported by this cohort; three of 88 (3.4%) participants had mastitis, one (1.1%) participant experienced breast engorgement, five of 88 (5.7%) participants reported cervical or axillary lymphadenopathy. There was no change in human milk supply after vaccination. The most common side effect was pain/redness/swelling at the injection site, which was experienced by 57 (64.8%) participants. There were no serious adverse events of anaphylaxis or hospital admissions. There were no short-term adverse effects reported in the infants of 67 lactating participants who breastfed within 72 hr after BNT162b2 vaccination. CONCLUSIONS BNT162b2 vaccination was well tolerated in lactating participants and was not associated with short-term adverse effects in their breastfed infants. STUDY PROTOCOL REGISTRATION The study protocol was registered at clinicaltrials.gov (NCT04802278).
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Affiliation(s)
- Jia Ming Low
- Department of Paediatrics, Yong Loo Lin School of Medicine, National University of Singapore, Singapore
- Department of Neonatology, Khoo Teck Puat-National University Children's Medical Institute, National University Health System, Singapore
| | - Le Ye Lee
- Department of Paediatrics, Yong Loo Lin School of Medicine, National University of Singapore, Singapore
- Department of Neonatology, Khoo Teck Puat-National University Children's Medical Institute, National University Health System, Singapore
| | - Yvonne Peng Mei Ng
- Department of Paediatrics, Yong Loo Lin School of Medicine, National University of Singapore, Singapore
- Department of Neonatology, Khoo Teck Puat-National University Children's Medical Institute, National University Health System, Singapore
| | - Youjia Zhong
- Department of Paediatrics, Yong Loo Lin School of Medicine, National University of Singapore, Singapore
- Khoo Teck Puat-National University Children's Medical Institute, National University Health System, Singapore
- Duke-NUS Medical School, Singapore
| | - Zubair Amin
- Department of Paediatrics, Yong Loo Lin School of Medicine, National University of Singapore, Singapore
- Department of Neonatology, Khoo Teck Puat-National University Children's Medical Institute, National University Health System, Singapore
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23
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Surasi DSS, Lin L, Ravizzini G, Wong F. Supraclavicular and Axillary Lymphadenopathy Induced by COVID-19 Vaccination on 18F-Fluorthanatrace, 68Ga-DOTATATE, and 18F-Fluciclovine PET/CT. Clin Nucl Med 2022; 47:195-196. [PMID: 34507331 DOI: 10.1097/rlu.0000000000003891] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
ABSTRACT COVID-19 vaccination has started in most countries, and postvaccination imaging is inevitable in the oncologic population. The immune response to the vaccination in the form of reactive lymphadenopathy has been well documented on 18F-FDG PET/CT. We present the imaging findings of 3 patients who have undergone non-FDG PET/CT imaging including 18F-fluorthanatrace, 68Ga-DOTATATE, and 18F-fluciclovine PET/CT. It is crucial to recognize the timing and laterality of immunization to avoid false-positive findings.
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Affiliation(s)
| | - Lilie Lin
- Division of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX
| | - Gregory Ravizzini
- From the Division of Diagnostic Imaging, Department of Nuclear Medicine
| | - Franklin Wong
- From the Division of Diagnostic Imaging, Department of Nuclear Medicine
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24
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Bshesh K, Khan W, Vattoth AL, Janjua E, Nauman A, Almasri M, Mohamed Ali A, Ramadorai V, Mushannen B, AlSubaie M, Mohammed I, Hammoud M, Paul P, Alkaabi H, Haji A, Laws S, Zakaria D. Lymphadenopathy Post‐COVID‐19 Vaccination with Increased FDG Uptake May Be Falsely Attributed to Oncological Disorders: A Systematic Review. J Med Virol 2022; 94:1833-1845. [PMID: 35060149 PMCID: PMC9015520 DOI: 10.1002/jmv.27599] [Citation(s) in RCA: 17] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/03/2021] [Revised: 12/28/2021] [Accepted: 01/14/2022] [Indexed: 11/17/2022]
Abstract
Coronavirus disease 2019 (COVID‐19) has caused a global pandemic that continues to cause numerous deaths to date. Four vaccines have been approved by the Food and Drug Administration as of July 2021 to prevent the transmission of COVID‐19: Pfizer, Moderna, AstraZeneca, and Janssen. These vaccines have shown great efficacy and safety profile. One side effect that has been widely reported is post‐COVID‐19 vaccination lymphadenopathy. Due to the mimicry of the lymphadenopathy for metastases in some oncologic patients, there have been reports of patients who underwent biopsies that showed pathologic confirmation of benign reactive lymphadenopathy secondary to the COVID‐19 vaccine. Therefore, understanding the incidence of lymphadenopathy post‐COVID‐19 vaccinations will help guide radiologists and oncologists in their management of patients, both present oncologic patients, and patients with concerns over their newly presenting lymphadenopathy. A systematic literature search was performed using several databases to identify relevant studies that reported lymphadenopathy post‐COVID‐19 vaccination. Our results revealed that several cases have been detected in patients undergoing follow‐up fluorodeoxyglucose (FDG)‐positron emission tomography‐computerized tomography scans where lymph nodes ipsilateral to the vaccine injection site show increased uptake of FDG. Thus, knowledge of the incidence of lymphadenopathy may help avoid unnecessary biopsies, interventions, and changes in management for patients, especially oncologic patients who are at risk for malignancies. Lymphadenopathy has been widely reported post‐COVID‐19 vaccination including patients undergoing follow‐up FDG‐PET‐CT scans which showed increased FDG uptake Care must be taken before suspecting lymph node metastasis or deciding for lymphadenectomy following COVID‐19 vaccination
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Affiliation(s)
- Khalifa Bshesh
- Division of Medical Education, Weill Cornell Medicine‐QatarQatar Foundation, Education CityDohaQatar
| | - Wafa Khan
- Division of Medical Education, Weill Cornell Medicine‐QatarQatar Foundation, Education CityDohaQatar
| | - Ahamed Lazim Vattoth
- Division of Medical Education, Weill Cornell Medicine‐QatarQatar Foundation, Education CityDohaQatar
| | - Emmad Janjua
- Division of Medical Education, Weill Cornell Medicine‐QatarQatar Foundation, Education CityDohaQatar
| | - Areej Nauman
- Division of Medical Education, Weill Cornell Medicine‐QatarQatar Foundation, Education CityDohaQatar
| | - Muna Almasri
- Division of Medical Education, Weill Cornell Medicine‐QatarQatar Foundation, Education CityDohaQatar
| | - Ateeque Mohamed Ali
- Division of Medical Education, Weill Cornell Medicine‐QatarQatar Foundation, Education CityDohaQatar
| | - Vinutha Ramadorai
- Division of Medical Education, Weill Cornell Medicine‐QatarQatar Foundation, Education CityDohaQatar
| | - Beshr Mushannen
- Division of Medical Education, Weill Cornell Medicine‐QatarQatar Foundation, Education CityDohaQatar
| | - Mai AlSubaie
- Division of Medical Education, Weill Cornell Medicine‐QatarQatar Foundation, Education CityDohaQatar
| | - Ibrahim Mohammed
- Division of Medical Education, Weill Cornell Medicine‐QatarQatar Foundation, Education CityDohaQatar
| | - Mais Hammoud
- Division of Medical Education, Weill Cornell Medicine‐QatarQatar Foundation, Education CityDohaQatar
| | - Pradipta Paul
- Division of Medical Education, Weill Cornell Medicine‐QatarQatar Foundation, Education CityDohaQatar
| | - Haya Alkaabi
- Division of Medical Education, Weill Cornell Medicine‐QatarQatar Foundation, Education CityDohaQatar
| | - Aliyaa Haji
- Division of Medical Education, Weill Cornell Medicine‐QatarQatar Foundation, Education CityDohaQatar
| | - Sa'ad Laws
- Distributed eLibrary, Weill Cornell Medicine‐QatarQatar Foundation, Education CityDohaQatar
| | - Dalia Zakaria
- Division of Premedical Education, Weill Cornell Medicine‐QatarQatar Foundation, Education CityDohaQatar
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25
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Eifer M, Tau N, Alhoubani Y, Kanana N, Domachevsky L, Shams J, Keret N, Gorfine M, Eshet Y. COVID-19 mRNA Vaccination: Age and Immune Status and Its Association with Axillary Lymph Node PET/CT Uptake. J Nucl Med 2022; 63:134-139. [PMID: 33893188 PMCID: PMC8717182 DOI: 10.2967/jnumed.121.262194] [Citation(s) in RCA: 46] [Impact Index Per Article: 23.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2021] [Revised: 04/21/2021] [Indexed: 11/17/2022] Open
Abstract
With hundreds of millions of coronavirus disease 2019 (COVID-19) messenger RNA (mRNA)-based vaccine doses planned to be delivered worldwide in the upcoming months, it is important to recognize PET/CT findings in recently vaccinated immunocompetent or immunocompromised patients. We aimed to assess PET/CT uptake in the deltoid muscle and axillary lymph nodes of patients who received a COVID-19 mRNA-based vaccine and to evaluate its association with patient age and immune status. Methods: All consecutive adults who underwent PET/CT scans with any radiotracer at our center during the first month of a national COVID-19 vaccination rollout (between December 23, 2020, and January 27, 2021) and had received the vaccination were included. Data on clinical status, laterality, and time from vaccination were prospectively collected, retrospectively analyzed, and correlated with deltoid muscle and axillary lymph node uptake. Results: Of 426 eligible subjects (median age, 67 ± 12 y; 49% female), 377 (88%) underwent PET/CT with 18F-FDG, and positive axillary lymph node uptake was seen in 45% of them. Multivariate logistic regression analysis revealed a strong inverse association between positive 18F-FDG uptake in ipsilateral lymph nodes and patient age (odds ratio [OR], 0.57; 95% CI, 0.45-0.72; P < 0.001), immunosuppressive treatment (OR, 0.37; 95% CI, 0.20-0.64; P = 0.003), and presence of hematologic disease (OR, 0.44; 95% CI, 0.24-0.8; P = 0.021). No such association was found for deltoid muscle uptake. The number of days from the last vaccination and the number of vaccine doses were also significantly associated with increased odds of positive lymph node uptake. Conclusion: After mRNA-based COVID-19 vaccination, a high proportion of patients showed ipsilateral lymph node axillary uptake, which was more common in immunocompetent patients. This information will help with the recognition of PET/CT pitfalls and may hint about the patient's immune response to the vaccine.
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Affiliation(s)
- Michal Eifer
- Department of Diagnostic Imaging, Chaim Sheba Medical Center, Ramat Gan, Israel;
- Sackler Faculty of Medicine, Tel-Aviv University, Tel Aviv, Israel; and
| | - Noam Tau
- Department of Diagnostic Imaging, Chaim Sheba Medical Center, Ramat Gan, Israel
- Sackler Faculty of Medicine, Tel-Aviv University, Tel Aviv, Israel; and
| | - Yousef Alhoubani
- Department of Diagnostic Imaging, Chaim Sheba Medical Center, Ramat Gan, Israel
| | - Nayroz Kanana
- Department of Diagnostic Imaging, Chaim Sheba Medical Center, Ramat Gan, Israel
- Sackler Faculty of Medicine, Tel-Aviv University, Tel Aviv, Israel; and
| | - Liran Domachevsky
- Department of Diagnostic Imaging, Chaim Sheba Medical Center, Ramat Gan, Israel
- Sackler Faculty of Medicine, Tel-Aviv University, Tel Aviv, Israel; and
| | - Jala Shams
- Department of Diagnostic Imaging, Chaim Sheba Medical Center, Ramat Gan, Israel
| | - Nir Keret
- Department of Statistics and Operations Research, Tel-Aviv University, Tel Aviv, Israel
| | - Malka Gorfine
- Department of Statistics and Operations Research, Tel-Aviv University, Tel Aviv, Israel
| | - Yael Eshet
- Department of Diagnostic Imaging, Chaim Sheba Medical Center, Ramat Gan, Israel
- Sackler Faculty of Medicine, Tel-Aviv University, Tel Aviv, Israel; and
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26
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Adin ME, Wu J, Isufi E, Tsui E, Pucar D. Ipsilateral Malignant Axillary Lymphadenopathy and Contralateral Reactive Lymph Nodes in a COVID-19 Vaccine Recipient With Breast Cancer. J Breast Cancer 2022; 25:140-144. [PMID: 35380021 PMCID: PMC9065355 DOI: 10.4048/jbc.2022.25.e12] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/31/2021] [Revised: 02/20/2022] [Accepted: 02/22/2022] [Indexed: 11/30/2022] Open
Abstract
Vaccine-related axillary nodal enlargement is a common benign condition that many mRNA vaccine receivers experience. However, a false attribution of axillary swelling to vaccination may result in delay in cancer care and potential disease progression, particularly in breast cancer patients presenting with ipsilateral axillary lymphadenopathy. We report the case of a 41-year-old pre-menopausal female who presented with suspicious axillary nodal enlargement and a right breast lump (triple-negative invasive ductal carcinoma) after recent administration of the second dose of Moderna mRNA coronavirus disease 2019 (COVID-19) vaccine. On imaging, bilateral axillary lymph nodes were detected. The ipsilateral right-sided node was proven to be metastatic, whereas contralateral nodes were related to a recent mRNA COVID-19 vaccination. Right-sided lymph node had intense uptake (maximum standardized uptake value [SUVmax] = 5), while the contralateral reactive nodes were mildly avid (SUVmax = 2.6). On magnetic resonance imaging, the right-sided node revealed asymmetric cortical thickening and marked cortical enhancement as opposed to normal-appearing left-sided nodes.
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Affiliation(s)
- Mehmet Emin Adin
- Department of Radiology and Biomedical Imaging, Yale School of Medicine, New Haven, USA
| | - Jennifer Wu
- Department of Radiology and Biomedical Imaging, Yale School of Medicine, New Haven, USA
| | - Edvin Isufi
- Department of Radiology and Biomedical Imaging, Yale School of Medicine, New Haven, USA
| | - Edison Tsui
- Department of Oncology, University of Massachusetts, Fall River, USA
| | - Darko Pucar
- Department of Radiology and Biomedical Imaging, Yale School of Medicine, New Haven, USA
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27
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Nawwar AA, Searle J, Hopkins R, Lyburn ID. False-Positive Axillary Lymph Nodes on FDG PET/CT Resulting From COVID-19 Immunization. Clin Nucl Med 2021; 46:1004-1005. [PMID: 33883486 PMCID: PMC8575105 DOI: 10.1097/rlu.0000000000003657] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2021] [Revised: 02/28/2021] [Accepted: 02/28/2021] [Indexed: 11/25/2022]
Abstract
ABSTRACT World-wide mass COVID-19 vaccination has been deployed starting with those most vulnerable, including the elderly and cancer patients. A 70-year-old man with right lung cancer underwent staging FDG PET/CT, which demonstrated an avid right lung mass with avid hilar and mediastinal nodes. Avid left axillary nodes of benign configuration were also noted. The patient had the Oxford-AstraZeneca COVID-19 vaccination in the left arm a week earlier. On reflection, the axillary nodes were concluded to be reactive related to this. This is a potential COVID-19 vaccination associated pitfall on PET/CT that should be considered when interpreting FDG PET/CT images.
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Affiliation(s)
- Ayah Adel Nawwar
- From the Cobalt Medical Charity, Cheltenham, United Kingdom
- Clinical Oncology and Nuclear Medicine Department, Cairo University, Cairo, Egypt
| | - Julie Searle
- From the Cobalt Medical Charity, Cheltenham, United Kingdom
- Gloucestershire Hospitals NHS Foundation Trust, Cheltenham
| | - Richard Hopkins
- From the Cobalt Medical Charity, Cheltenham, United Kingdom
- Gloucestershire Hospitals NHS Foundation Trust, Cheltenham
| | - Iain Douglas Lyburn
- From the Cobalt Medical Charity, Cheltenham, United Kingdom
- Gloucestershire Hospitals NHS Foundation Trust, Cheltenham
- Cranfield Forensic Institute, Cranfield University at Shrivenham, Swindon, United Kingdom
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28
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Usmani S, Al-Ramadhan F, Al-Kandari F, Ahmed N. Fluorine-18 Fluorodeoxyglucose Positron Emission Tomography/Computed Tomography in Hodgkin's Lymphoma: Diagnostic Challenge during COVID Vaccination. Indian J Nucl Med 2021; 36:343-346. [PMID: 34658564 PMCID: PMC8481852 DOI: 10.4103/ijnm.ijnm_31_21] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2021] [Revised: 03/08/2021] [Accepted: 03/11/2021] [Indexed: 11/10/2022] Open
Abstract
Benign metabolic uptake on fluorine-18 fluorodeoxyglucose positron emission tomography (18F-FDG PET) is not uncommonly seen after immunization. We report a case of 30-year-old man with Hodgkin's lymphoma who underwent two cycles of chemotherapy. Interim 18F-FDG PET/computed tomography demonstrated complete metabolic response of prior hypermetabolic bilateral supraclavicular and mediastinal lymph nodes. Although multiple new normal-sized hypermetabolic left axillary and subpectoral lymph nodes are noted, relevant history revealed COVID vaccine 7 days prior scan with mild FDG uptake at the left deltoid muscle. These new findings at the left axilla are likely related to recent vaccination. 18F-FDG PET uptake in the lymph nodes is not so uncommon after immunization; relevant history is very important especially in the phase of massive immunization to avoid false interpretation.
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Affiliation(s)
- Sharjeel Usmani
- Department of Nuclear Medicine, Castle Hill Hospital, Cottingham, UK
| | | | | | - Najeeb Ahmed
- Jack Brignall PET/CT Centre, Castle Hill Hospital, Cottingham, UK
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29
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Ha SM, Chang JM. Precautions for breast ultrasound examination following COVID-19 vaccination. JOURNAL OF THE KOREAN MEDICAL ASSOCIATION 2021. [DOI: 10.5124/jkma.2021.64.10.671] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Abstract
Background: Coronavirus disease 2019 (COVID-19) vaccine-induced lymphadenopathy is a critical side effect that should be a concern to clinicians, patients, radiologists, and oncologists. Vaccine-induced lymphadenopathy causes a diagnostic dilemma, especially for breast radiologists who examine both axillary regions during breast ultrasound examinations. Appropriate imaging guidelines are needed to manage vaccine-induced lymphadenopathy for patients undergoing screening examinations or symptomatic patients, including cancer patients.Current Concepts: For patients with axillary lymphadenopathy in the setting of recent ipsilateral vaccination, clinical follow-up is recommended. In other scenarios, short-term follow-up axillary ultrasound examinations are recommended if the clinical concerns persist for more than 6 weeks after vaccination. To mitigate the diagnostic dilemma of vaccine-induced lymphadenopathy, patients should schedule screening imaging examinations before the first vaccination or at least six weeks following the second vaccination. For clinicians and radiologists, documenting the patients’ vaccination status is critical to decreasing unnecessary follow-up imaging, biopsies, and patient’s anxiety.Discussion and Conclusion: Our proposal can help reduce patient anxiety, provider burden, and costs of unnecessary evaluation of enlarged lymph nodes in the setting of recent COVID-19 vaccination. Further, it can avoid delays in vaccination and breast cancer screening during the COVID-19 pandemic.
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30
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Shin M, Hyun CY, Choi YH, Choi JY, Lee KH, Cho YS. COVID-19 Vaccination-Associated Lymphadenopathy on FDG PET/CT: Distinctive Features in Adenovirus-Vectored Vaccine. Clin Nucl Med 2021; 46:814-819. [PMID: 34115709 PMCID: PMC8411598 DOI: 10.1097/rlu.0000000000003800] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2021] [Revised: 05/13/2021] [Accepted: 05/13/2021] [Indexed: 11/26/2022]
Abstract
PURPOSE This study investigated 18F-FDG PET/CT features of adenovirus-vectored vaccination against COVID-19 in healthy subjects. PATIENTS AND METHODS Thirty-one health care workers had been vaccinated Vaxzevria and underwent FDG PET/CT as an optional test for a cancer screening program. Size and FDG uptake of the hypermetabolic lymph nodes were measured. Uptake value of spleen was also measured with liver for comparison. RESULTS All examinees who underwent FDG PET/CT within 14 days' interval showed hypermetabolic lymphadenopathies ipsilateral to vaccine injection. All examinees with hypermetabolic lymphadenopathy had simultaneous muscular uptakes until 23 days' interval. Among 12 examinees who underwent FDG PET/CT more than 15 days after vaccination, only 3 male examinees did not show hypermetabolism in the axillary lymph nodes. There was no female examinee with negative hypermetabolic lymphadenopathy until 29 days after vaccination. CONCLUSIONS Hypermetabolic reactive lymphadenopathy in the ipsilateral axillary area with or without supraclavicular area is most likely to occur in a healthy person with recent adenovirus-vectored COVID-19 vaccination on FDG PET/CT.
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Affiliation(s)
| | | | - Yoon Ho Choi
- Center for Health Promotion, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, South Korea
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31
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Cervical lymphadenopathy following coronavirus disease 2019 vaccine: clinical characteristics and implications for head and neck cancer services. The Journal of Laryngology & Otology 2021; 135:1025-1030. [PMID: 34526175 PMCID: PMC8476898 DOI: 10.1017/s0022215121002462] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
Objective Patients with coronavirus disease vaccine associated lymphadenopathy are increasingly being referred to healthcare services. This work is the first to report on the incidence, clinical course and imaging features of coronavirus disease vaccine associated cervical lymphadenopathy, with special emphasis on the implications for head and neck cancer services. Methods This was a retrospective cohort study of all patients referred to our head and neck cancer clinics between 16 December 2020 and 12 March 2021. The main outcomes measured were the proportion of patients with vaccine-associated cervical lymphadenopathy, and the clinical and imaging characteristics. Results The incidence of vaccine-associated cervical lymphadenopathy referrals was 14.8 per cent (n = 13). Five patients (38.5 per cent) had abnormal-looking enlarged and rounded nodes with increased vascularity. Only seven patients (53.9 per cent) reported full resolution within an average of 3.1 ± 2.3 weeks. Conclusion Coronavirus disease vaccine associated cervical lymphadenopathy can mimic malignant lymphadenopathy and therefore might prove challenging to diagnose and manage correctly. Healthcare services may encounter a significant increase in referrals.
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32
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Ferrari C, Nappi AG, Santo G, Mammucci P, Rubini D, Tucci M, Pisani AR. The Day after Mass COVID-19 Vaccination: Higher Hypermetabolic Lymphadenopathy Detection on PET/CT and Impact on Oncologic Patients Management. Cancers (Basel) 2021; 13:cancers13174340. [PMID: 34503150 PMCID: PMC8431447 DOI: 10.3390/cancers13174340] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2021] [Revised: 08/19/2021] [Accepted: 08/25/2021] [Indexed: 12/25/2022] Open
Abstract
The widespread COVID-19 vaccination led to unexpected PET findings. Notably, axillary and interpectoral lymphadenopathies ipsilateral to the vaccine inoculation were observed. We aimed to assess the hypermetabolic lymphadenopathy (HLN) detection rate on PET/CT. Secondly, we investigated factors that might help in HLN differential diagnosis. A retrospective analysis on 1196 consecutive patients referred for a PET/CT was performed. All patients were asked about the date, type and site of vaccine injections. HLNs were recorded and categorized according to risk classes and SUVmax grades. A statistical analysis was performed to assess the correlation between HLN detection and different clinical/vaccine data. HLN detection rate was 15% and 27% in the No Vac- and vac-groups (p < 0.001), respectively. In the Vac-group, age (p < 0.001) and time interval from vaccine-to-PET (p = 0.010) were inversely correlated with HLN detection. Furthermore, SUVmax significantly changed during time intervals, with lower values beyond 20 days (p < 0.001). In the era of mass COVID-19 vaccination, a higher axillary and interpectoral lymphadenopathies detection ipsilateral to vaccine injection was observed. These PET findings can be wrongly interpreted, complicating cancer patients' management. To minimize these pitfalls, a detailed vaccination anamnesis must be recorded and should take into account the appropriate PET schedule.
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Affiliation(s)
- Cristina Ferrari
- Section of Nuclear Medicine, Interdisciplinary Department of Medicine, University of Bari Aldo Moro, Piazza Giulio Cesare 11, 70124 Bari, Italy; (A.G.N.); (G.S.); (P.M.); (D.R.); (A.R.P.)
- Correspondence: ; Tel.: +39-080-5595-039
| | - Anna Giulia Nappi
- Section of Nuclear Medicine, Interdisciplinary Department of Medicine, University of Bari Aldo Moro, Piazza Giulio Cesare 11, 70124 Bari, Italy; (A.G.N.); (G.S.); (P.M.); (D.R.); (A.R.P.)
| | - Giulia Santo
- Section of Nuclear Medicine, Interdisciplinary Department of Medicine, University of Bari Aldo Moro, Piazza Giulio Cesare 11, 70124 Bari, Italy; (A.G.N.); (G.S.); (P.M.); (D.R.); (A.R.P.)
| | - Paolo Mammucci
- Section of Nuclear Medicine, Interdisciplinary Department of Medicine, University of Bari Aldo Moro, Piazza Giulio Cesare 11, 70124 Bari, Italy; (A.G.N.); (G.S.); (P.M.); (D.R.); (A.R.P.)
| | - Dino Rubini
- Section of Nuclear Medicine, Interdisciplinary Department of Medicine, University of Bari Aldo Moro, Piazza Giulio Cesare 11, 70124 Bari, Italy; (A.G.N.); (G.S.); (P.M.); (D.R.); (A.R.P.)
| | - Marco Tucci
- Division of Medical Oncology, Department of Biomedical Sciences and Human Oncology, University of Bari Aldo Moro, 70121 Bari, Italy;
| | - Antonio Rosario Pisani
- Section of Nuclear Medicine, Interdisciplinary Department of Medicine, University of Bari Aldo Moro, Piazza Giulio Cesare 11, 70124 Bari, Italy; (A.G.N.); (G.S.); (P.M.); (D.R.); (A.R.P.)
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COVID-19 Vaccination-Related Uptake on FDG PET/CT: An Emerging Dilemma and Suggestions for Management. AJR Am J Roentgenol 2021; 217:975-983. [DOI: 10.2214/ajr.21.25728] [Citation(s) in RCA: 50] [Impact Index Per Article: 16.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/07/2023]
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Prevalence and Significance of Hypermetabolic Lymph Nodes Detected by 2-[ 18F]FDG PET/CT after COVID-19 Vaccination: A Systematic Review and a Meta-Analysis. Pharmaceuticals (Basel) 2021; 14:ph14080762. [PMID: 34451859 PMCID: PMC8401863 DOI: 10.3390/ph14080762] [Citation(s) in RCA: 24] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2021] [Revised: 08/02/2021] [Accepted: 08/02/2021] [Indexed: 02/01/2023] Open
Abstract
Recently, several articles reported incidental findings at 2-[18F]FDG PET/CT in patients who have received COVID-19 vaccinations, including hypermetabolic axillary lymph nodes (HALNs) ipsilateral to the COVID-19 vaccine injection site which may cause diagnostic dilemmas. The aim of our work was to calculate the prevalence of this finding. A comprehensive computer literature search of PubMed/MEDLINE, Embase, and Cochrane library databases was performed to identify recently published articles that investigated the prevalence of HALNs detected by 2-[18F]FDG PET/CT after COVID-19 vaccination. Pooled prevalence of this finding was calculated through a meta-analytic approach. Nine recently published articles including 2354 patients undergoing 2-[18F]FDG PET/CT after recent COVID-19 vaccination have been included in the systematic review. Overall, HALNs ipsilateral to the vaccine injection site were frequent findings mainly due to vaccine-related immune response in most of the cases. The pooled prevalence of HALNs after COVID-19 vaccination was 37% (95% confidence interval: 27–47%) but with significant heterogeneity among the included studies. Physicians must be aware and recognize the significant frequency of HALNs at 2-[18F]FDG PET/CT related to immune response to vaccine injection. Larger studies are needed to confirm the findings of this systematic review and meta-analysis.
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Adin ME, Isufi E, Kulon M, Pucar D. Association of COVID-19 mRNA Vaccine With Ipsilateral Axillary Lymph Node Reactivity on Imaging. JAMA Oncol 2021; 7:1241-1242. [PMID: 34110378 PMCID: PMC8193545 DOI: 10.1001/jamaoncol.2021.1794] [Citation(s) in RCA: 35] [Impact Index Per Article: 11.7] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2021] [Accepted: 04/14/2021] [Indexed: 11/14/2022]
Affiliation(s)
- Mehmet Emin Adin
- Department of Radiology and Biomedical Imaging, Yale School of Medicine, New Haven, Connecticut
| | - Edvin Isufi
- Department of Radiology and Biomedical Imaging, Yale School of Medicine, New Haven, Connecticut
| | - Michal Kulon
- Department of Radiology and Biomedical Imaging, Yale School of Medicine, New Haven, Connecticut
| | - Darko Pucar
- Department of Radiology and Biomedical Imaging, Yale School of Medicine, New Haven, Connecticut
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36
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Schapiro R, Moncayo VM, Meisel JL. Case report of lymph node activation mimicking cancer progression: A false positive F 18 FDG PET CT after COVID-19 vaccination. CURRENT PROBLEMS IN CANCER: CASE REPORTS 2021; 4:100092. [PMID: 34308402 PMCID: PMC8233411 DOI: 10.1016/j.cpccr.2021.100092] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2021] [Revised: 06/18/2021] [Accepted: 06/22/2021] [Indexed: 11/28/2022] Open
Abstract
This case illustrates a false positive F18 FDG PET CT in the left axilla of a woman being treated for metastatic breast cancer after COVID-19 vaccination. Follow-up ultrasound of the axilla indicated no metastasis, indicating that the lymphadenopathy was likely due to an immune response following vaccination. This case report, in conjunction with prior studies of other vaccines with similar findings suggest that providers should be aware of potential false positive imaging following COVID-19 vaccination. In light of these findings, clinicians and imaging providers should record the date and side of the vaccination and inform patient of potential false positive results to reduce patient anxiety and unnecessary tests as COVID-19 vaccines become widely available.
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Affiliation(s)
- Rebecca Schapiro
- 3400 Civic Center Blvd, Philadelphia, PA19104, United States of America
| | - Valeria M Moncayo
- 1364 Clifton Road Northeast, Atlanta, GA30322, United States of America
| | - Jane L Meisel
- 1365 E Clifton Rd NE Building C, Atlanta, GA30322, United States of America
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37
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Orevi M, Chicheportiche A, Ben-Haim S. Lessons learned from post-COVID-19 vaccination PET/CT studies. J Nucl Med 2021; 63:453-460. [PMID: 34301777 PMCID: PMC8978202 DOI: 10.2967/jnumed.121.262348] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2021] [Revised: 06/14/2021] [Indexed: 11/16/2022] Open
Abstract
Vaccination against coronavirus 2019 (COVID-19) has created new challenges. Lymphadenopathy with increased uptake in patients undergoing PET/CT may mislead to unnecessary further evaluation. We have analyzed routinely performed PET/CT studies after Pfizer-BioNTech vaccination to familiarize ourselves with the PET/CT appearance of various PET tracers and to prevent the consequences of misinterpretation. Methods: We analyzed 1,018 PET/CT studies performed between January 1, 2021, and February 15, 2021. Information about the dates and sites of vaccination was collected. Visual and semiquantitative analysis of axillary–neck lymphadenopathy and arm uptake was correlated with immunization data. Results: Increased uptake in axillary lymphadenopathy was observed unilaterally in 66% of vaccinated patients, in 55% of patients vaccinated once, and in 69% of those vaccinated twice. The intensity of uptake decreased over time. Fifty-four of 274 patients (20%) had simultaneous increased activity in the posterior arm and ipsilateral axillary lymphadenopathy (double sign [DS]). The sensitivity, specificity, positive predictive value, and negative predictive value were 55.4%, 83.6%, 86.7%, 49.2%, respectively, for axillary lymphadenopathy and 38.6%, 100%, 100%, and 66.1%, respectively, for DS. No DS was observed later than 10 and 21 d after the first and the second vaccinations, respectively. None of the nonvaccinated patients had arm uptake or DS. Conclusion: Vaccination against COVID-19 frequently causes nonspecific axillary lymphadenopathy with increased PET tracer activity. In one fifth of our study population, this lymphadenopathy was associated with increased uptake at the vaccination site, DS. DS was 100% specific, with a 100% positive predictive value for postvaccination lymphadenopathy, hence enabling avoidance of misinterpretation of PET/CT studies and further unnecessary evaluation.
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Affiliation(s)
- Marina Orevi
- Department of Nuclear Medicine and Biophysics, Hadassah Medical Organization, Israel
| | | | - Simona Ben-Haim
- Department of Nuclear Medicine and Biophysics, Hadassah Medical Organization, Israel
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38
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Barber-Axthelm IM, Kelly HG, Esterbauer R, Wragg KM, Gibbon AM, Lee WS, Wheatley AK, Kent SJ, Tan HX, Juno JA. Coformulation with Tattoo Ink for Immunological Assessment of Vaccine Immunogenicity in the Draining Lymph Node. THE JOURNAL OF IMMUNOLOGY 2021; 207:735-744. [PMID: 34244296 DOI: 10.4049/jimmunol.2001299] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/18/2020] [Accepted: 05/17/2021] [Indexed: 11/19/2022]
Abstract
Characterization of germinal center B and T cell responses yields critical insights into vaccine immunogenicity. Nonhuman primates are a key preclinical animal model for human vaccine development, allowing both lymph node (LN) and circulating immune responses to be longitudinally sampled for correlates of vaccine efficacy. However, patterns of vaccine Ag drainage via the lymphatics after i.m. immunization can be stochastic, driving uneven deposition between lymphoid sites and between individual LN within larger clusters. To improve the accurate isolation of Ag-exposed LN during biopsies and necropsies, we developed and validated a method for coformulating candidate vaccines with tattoo ink in both mice and pigtail macaques. This method allowed for direct visual identification of vaccine-draining LN and evaluation of relevant Ag-specific B and T cell responses by flow cytometry. This approach is a significant advancement in improving the assessment of vaccine-induced immunity in highly relevant nonhuman primate models.
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Affiliation(s)
- Isaac M Barber-Axthelm
- Department of Microbiology and Immunology, University of Melbourne at the Peter Doherty Institute for Infection and Immunity, Melbourne Victoria, Australia
| | - Hannah G Kelly
- Department of Microbiology and Immunology, University of Melbourne at the Peter Doherty Institute for Infection and Immunity, Melbourne Victoria, Australia.,Australian Research Council Centre for Excellence in Convergent Bio-Nano Science and Technology, University of Melbourne, Melbourne, Victoria, Australia
| | - Robyn Esterbauer
- Department of Microbiology and Immunology, University of Melbourne at the Peter Doherty Institute for Infection and Immunity, Melbourne Victoria, Australia
| | - Kathleen M Wragg
- Department of Microbiology and Immunology, University of Melbourne at the Peter Doherty Institute for Infection and Immunity, Melbourne Victoria, Australia
| | - Anne M Gibbon
- Monash Animal Research Platform, Monash University, Clayton, Victoria, Australia; and
| | - Wen Shi Lee
- Department of Microbiology and Immunology, University of Melbourne at the Peter Doherty Institute for Infection and Immunity, Melbourne Victoria, Australia
| | - Adam K Wheatley
- Department of Microbiology and Immunology, University of Melbourne at the Peter Doherty Institute for Infection and Immunity, Melbourne Victoria, Australia
| | - Stephen J Kent
- Department of Microbiology and Immunology, University of Melbourne at the Peter Doherty Institute for Infection and Immunity, Melbourne Victoria, Australia.,Australian Research Council Centre for Excellence in Convergent Bio-Nano Science and Technology, University of Melbourne, Melbourne, Victoria, Australia.,Melbourne Sexual Health Centre and Department of Infectious Diseases, Alfred Hospital and Central Clinical School, Monash University, Melbourne, Victoria, Australia
| | - Hyon-Xhi Tan
- Department of Microbiology and Immunology, University of Melbourne at the Peter Doherty Institute for Infection and Immunity, Melbourne Victoria, Australia
| | - Jennifer A Juno
- Department of Microbiology and Immunology, University of Melbourne at the Peter Doherty Institute for Infection and Immunity, Melbourne Victoria, Australia;
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Coordination and optimization of FDG PET/CT and COVID-19 vaccination; Lessons learned in the early stages of mass vaccination. Cancer Treat Rev 2021; 98:102220. [PMID: 34029956 PMCID: PMC8110324 DOI: 10.1016/j.ctrv.2021.102220] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2021] [Revised: 05/05/2021] [Accepted: 05/06/2021] [Indexed: 01/04/2023]
Abstract
As the world embarks on mass vaccination for COVID-19, we are beginning to encounter unintended dilemmas in imaging oncology patients; particularly with regards to FDG PET/CT. In some cases, vaccine-related lymphadenopathy and FDG uptake on PET/CT can mimic cancer and lead to confounding imaging results. These cases where findings overlap with cancer pose a significant dilemma for diagnostic purposes, follow-up, and management leading to possible treatment delays, unnecessary repeat imaging and sampling, and patient anxiety. These cases can largely be avoided by optimal coordination between vaccination and planned imaging as well as preemptive selection of vaccine administration site. This coordination hinges on patient, oncologist, and radiologists' awareness of this issue and collaboration. Through close communication and patient education, we believe this will eliminate significant challenges for our oncology patients as we strive to end this pandemic.
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40
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Minamimoto R, Kiyomatsu T. Effects of COVID-19 vaccination on FDG-PET/CT imaging: A literature review. Glob Health Med 2021; 3:129-133. [PMID: 34250287 PMCID: PMC8239370 DOI: 10.35772/ghm.2021.01076] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2021] [Revised: 06/24/2021] [Accepted: 06/26/2021] [Indexed: 05/13/2023]
Abstract
COVID-19 vaccination using mRNA technology began at the end of 2020 in several countries, approximately 9 months after the WHO declared the new coronavirus a pandemic, and began in Japan at the end of February 2021. Several studies have reported FDG avidity in enlarged axillary lymph nodes as a specific feature of FDG-PET/CT imaging after COVID-19 vaccination. A major concern is that this finding could lead to a misdiagnosis in patients with various types of malignancy. We review the impact of COVID-19 vaccination on the management of patients scheduled for FDG-PET/CT in the setting of nationwide mass vaccination.
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Affiliation(s)
- Ryogo Minamimoto
- Division of Nuclear Medicine, Department of Radiology, National Center for Global Health and Medicine, Tokyo, Japan
- Address correspondence to:Ryogo Minamimoto, Division of Nuclear Medicine, Department of Radiology, National Center for Global Health and Medicine, 1-21-1, Toyama, Shinjyuku-ku, Tokyo, 162- 8655, Japan. E-mail:
| | - Tomomichi Kiyomatsu
- Department of Surgery, National Center for Global Health and Medicine, Tokyo, Japan
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41
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Lehman CD, D'Alessandro HA, Mendoza DP, Succi MD, Kambadakone A, Lamb LR. Unilateral Lymphadenopathy After COVID-19 Vaccination: A Practical Management Plan for Radiologists Across Specialties. J Am Coll Radiol 2021; 18:843-852. [PMID: 33713605 PMCID: PMC7931722 DOI: 10.1016/j.jacr.2021.03.001] [Citation(s) in RCA: 37] [Impact Index Per Article: 12.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2021] [Revised: 02/27/2021] [Accepted: 03/01/2021] [Indexed: 02/06/2023]
Abstract
Reports are rising of patients with unilateral axillary lymphadenopathy, visible on diverse imaging examinations, after recent coronavirus disease 2019 vaccination. With less than 10% of the US population fully vaccinated, we can prepare now for informed care of patients imaged after recent vaccination. The authors recommend documenting vaccination information (date[s] of vaccination[s], injection site [left or right, arm or thigh], type of vaccine) on intake forms and having this information available to the radiologist at the time of examination interpretation. These recommendations are based on three key factors: the timing and location of the vaccine injection, clinical context, and imaging findings. The authors report isolated unilateral axillary lymphadenopathy (i.e., no imaging findings outside of visible lymphadenopathy), which is ipsilateral to recent (prior 6 weeks) vaccination, as benign with no further imaging indicated. Clinical management is recommended, with ultrasound if clinical concern persists 6 weeks after the final vaccination dose. In the clinical setting to stage a recent cancer diagnosis or assess response to therapy, the authors encourage prompt recommended imaging and vaccination (possibly in the thigh or contralateral arm according to the location of the known cancer). Management in this clinical context of a current cancer diagnosis is tailored to the specific case, ideally with consultation between the oncology treatment team and the radiologist. The aim of these recommendations is to (1) reduce patient anxiety, provider burden, and costs of unnecessary evaluation of enlarged nodes in the setting of recent vaccination and (2) avoid further delays in vaccinations and recommended imaging for best patient care during the pandemic.
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Affiliation(s)
- Constance D Lehman
- Chief of Breast Imaging, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts.
| | - Helen Anne D'Alessandro
- Department of Radiology, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts
| | - Dexter P Mendoza
- Department of Radiology, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts
| | - Marc D Succi
- Department of Radiology, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts
| | - Avinash Kambadakone
- Chief of Abdominal Imaging, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts
| | - Leslie R Lamb
- Department of Radiology, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts
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42
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Cohen D, Krauthammer SH, Wolf I, Even-Sapir E. Hypermetabolic lymphadenopathy following administration of BNT162b2 mRNA Covid-19 vaccine: incidence assessed by [ 18F]FDG PET-CT and relevance to study interpretation. Eur J Nucl Med Mol Imaging 2021; 48:1854-1863. [PMID: 33774684 PMCID: PMC8003894 DOI: 10.1007/s00259-021-05314-2] [Citation(s) in RCA: 87] [Impact Index Per Article: 29.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2021] [Accepted: 03/09/2021] [Indexed: 01/16/2023]
Abstract
PURPOSE Nationwide mass vaccination against Covid-19 started in Israel in late 2020. Soon we identified on [18F]FDG PET-CT studies vaccine-associated hypermetabolic lymphadenopathy (VAHL) in axillary or supraclavicular lymph nodes (ASLN) ipsilateral to the vaccination site. Sometimes, differentiation between the malignant and benign nature of the hypermetabolic lymphadenopathy (HLN) could not be made, and equivocal HLN (EqHL) was reported. The purpose of the study was to determine the overall incidence of VAHL after BNT162b2 vaccination and also its relevance to PET-CT interpretation in oncologic patients. METHODS A total of 951 consecutive patients that underwent [18F]FDG PET-CT studies in our department were interviewed regarding the sites and dates of the vaccine doses. A total of 728 vaccinated patients (All-Vac group) were included: 346 received the first dose only (Vac-1 group) and 382 received the booster dose as well (Vac-2 group). Studies were categorized as no HLN, malignant-HLN (MHL), VAHL, or EqHL. In studies with VAHL, location, [18F]FDG-intensity uptake and nodes size were recorded. RESULTS The incidences of HLN were 45.6%, 36.4%, and 53.9% in All-Vac, Vac-1, and Vac-2 groups, respectively. VAHL was reported in 80.1% of vaccinated patients with HLN. Lower incidences of VAHL were found during the first 5 days or in the third week after the first vaccine and beyond 20 days after the booster dose. In 49 of 332 (14.8%) vaccinated patients, we could not determine whether HLN was MHL or VAHL. Breast cancer and lymphoma were the leading diseases with EqHL. CONCLUSION VAHL is frequently observed after BNT162b2 administration, more commonly and with higher intensity following the booster dose. To minimize false and equivocal reports in oncological patients, timing of [18F]FDG PET-CT should be based on the time intervals found to have a lower incidence of VAHL, and choice of vaccine injection site should be advised, mainly in patients where ASLN are a relevant site of tumor involvement.
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Affiliation(s)
- Dan Cohen
- Department of Nuclear Medicine, Tel-Aviv Sourasky Medical Center, 6 Weizmann St, 6423906, Tel Aviv, Israel
| | - Shir Hazut Krauthammer
- Department of Nuclear Medicine, Tel-Aviv Sourasky Medical Center, 6 Weizmann St, 6423906, Tel Aviv, Israel
| | - Ido Wolf
- Institute of Oncology, Tel-Aviv Sourasky Medical Center, 6 Weizmann St, 6423906, Tel Aviv, Israel
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Einat Even-Sapir
- Department of Nuclear Medicine, Tel-Aviv Sourasky Medical Center, 6 Weizmann St, 6423906, Tel Aviv, Israel.
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel.
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Van Tilbeurgh M, Lemdani K, Beignon AS, Chapon C, Tchitchek N, Cheraitia L, Marcos Lopez E, Pascal Q, Le Grand R, Maisonnasse P, Manet C. Predictive Markers of Immunogenicity and Efficacy for Human Vaccines. Vaccines (Basel) 2021; 9:579. [PMID: 34205932 PMCID: PMC8226531 DOI: 10.3390/vaccines9060579] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2021] [Revised: 05/22/2021] [Accepted: 05/24/2021] [Indexed: 02/07/2023] Open
Abstract
Vaccines represent one of the major advances of modern medicine. Despite the many successes of vaccination, continuous efforts to design new vaccines are needed to fight "old" pandemics, such as tuberculosis and malaria, as well as emerging pathogens, such as Zika virus and severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). Vaccination aims at reaching sterilizing immunity, however assessing vaccine efficacy is still challenging and underscores the need for a better understanding of immune protective responses. Identifying reliable predictive markers of immunogenicity can help to select and develop promising vaccine candidates during early preclinical studies and can lead to improved, personalized, vaccination strategies. A systems biology approach is increasingly being adopted to address these major challenges using multiple high-dimensional technologies combined with in silico models. Although the goal is to develop predictive models of vaccine efficacy in humans, applying this approach to animal models empowers basic and translational vaccine research. In this review, we provide an overview of vaccine immune signatures in preclinical models, as well as in target human populations. We also discuss high-throughput technologies used to probe vaccine-induced responses, along with data analysis and computational methodologies applied to the predictive modeling of vaccine efficacy.
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Affiliation(s)
- Matthieu Van Tilbeurgh
- Immunology of Viral Infections and Autoimmune Diseases (IMVA), IDMIT Department, Institut de Biologie François-Jacob (IBJF), University Paris-Sud—INSERM U1184, CEA, 92265 Fontenay-Aux-Roses, France; (M.V.T.); (K.L.); (A.-S.B.); (C.C.); (L.C.); (E.M.L.); (Q.P.); (R.L.G.); (P.M.)
| | - Katia Lemdani
- Immunology of Viral Infections and Autoimmune Diseases (IMVA), IDMIT Department, Institut de Biologie François-Jacob (IBJF), University Paris-Sud—INSERM U1184, CEA, 92265 Fontenay-Aux-Roses, France; (M.V.T.); (K.L.); (A.-S.B.); (C.C.); (L.C.); (E.M.L.); (Q.P.); (R.L.G.); (P.M.)
| | - Anne-Sophie Beignon
- Immunology of Viral Infections and Autoimmune Diseases (IMVA), IDMIT Department, Institut de Biologie François-Jacob (IBJF), University Paris-Sud—INSERM U1184, CEA, 92265 Fontenay-Aux-Roses, France; (M.V.T.); (K.L.); (A.-S.B.); (C.C.); (L.C.); (E.M.L.); (Q.P.); (R.L.G.); (P.M.)
| | - Catherine Chapon
- Immunology of Viral Infections and Autoimmune Diseases (IMVA), IDMIT Department, Institut de Biologie François-Jacob (IBJF), University Paris-Sud—INSERM U1184, CEA, 92265 Fontenay-Aux-Roses, France; (M.V.T.); (K.L.); (A.-S.B.); (C.C.); (L.C.); (E.M.L.); (Q.P.); (R.L.G.); (P.M.)
| | - Nicolas Tchitchek
- Unité de Recherche i3, Inserm UMR-S 959, Bâtiment CERVI, Hôpital de la Pitié-Salpêtrière, 75013 Paris, France;
| | - Lina Cheraitia
- Immunology of Viral Infections and Autoimmune Diseases (IMVA), IDMIT Department, Institut de Biologie François-Jacob (IBJF), University Paris-Sud—INSERM U1184, CEA, 92265 Fontenay-Aux-Roses, France; (M.V.T.); (K.L.); (A.-S.B.); (C.C.); (L.C.); (E.M.L.); (Q.P.); (R.L.G.); (P.M.)
| | - Ernesto Marcos Lopez
- Immunology of Viral Infections and Autoimmune Diseases (IMVA), IDMIT Department, Institut de Biologie François-Jacob (IBJF), University Paris-Sud—INSERM U1184, CEA, 92265 Fontenay-Aux-Roses, France; (M.V.T.); (K.L.); (A.-S.B.); (C.C.); (L.C.); (E.M.L.); (Q.P.); (R.L.G.); (P.M.)
| | - Quentin Pascal
- Immunology of Viral Infections and Autoimmune Diseases (IMVA), IDMIT Department, Institut de Biologie François-Jacob (IBJF), University Paris-Sud—INSERM U1184, CEA, 92265 Fontenay-Aux-Roses, France; (M.V.T.); (K.L.); (A.-S.B.); (C.C.); (L.C.); (E.M.L.); (Q.P.); (R.L.G.); (P.M.)
| | - Roger Le Grand
- Immunology of Viral Infections and Autoimmune Diseases (IMVA), IDMIT Department, Institut de Biologie François-Jacob (IBJF), University Paris-Sud—INSERM U1184, CEA, 92265 Fontenay-Aux-Roses, France; (M.V.T.); (K.L.); (A.-S.B.); (C.C.); (L.C.); (E.M.L.); (Q.P.); (R.L.G.); (P.M.)
| | - Pauline Maisonnasse
- Immunology of Viral Infections and Autoimmune Diseases (IMVA), IDMIT Department, Institut de Biologie François-Jacob (IBJF), University Paris-Sud—INSERM U1184, CEA, 92265 Fontenay-Aux-Roses, France; (M.V.T.); (K.L.); (A.-S.B.); (C.C.); (L.C.); (E.M.L.); (Q.P.); (R.L.G.); (P.M.)
| | - Caroline Manet
- Immunology of Viral Infections and Autoimmune Diseases (IMVA), IDMIT Department, Institut de Biologie François-Jacob (IBJF), University Paris-Sud—INSERM U1184, CEA, 92265 Fontenay-Aux-Roses, France; (M.V.T.); (K.L.); (A.-S.B.); (C.C.); (L.C.); (E.M.L.); (Q.P.); (R.L.G.); (P.M.)
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Frequency and Characteristics of Nodal and Deltoid FDG and 11C-Choline Uptake on PET Imaging Performed After COVID-19 Vaccination. AJR Am J Roentgenol 2021; 217:1206-1216. [PMID: 34009000 DOI: 10.2214/ajr.21.25928] [Citation(s) in RCA: 29] [Impact Index Per Article: 9.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
Background: COVID-19 vaccination may trigger reactive lymphadenopathy, confounding imaging interpretation. There has been limited systematic analysis of PET findings after COVID-19 vaccination. Objective: To evaluate the frequency and characteristics of abnormal FDG and 11C-choline uptake on PET imaging performed after COVID-19 vaccination. Methods: This retrospective study included 67 patients (mean age 75.6±9.2 years; 43 men, 24 women) who underwent PET examination (PET/CT in 66, PET/MRI in 1; FDG in 54, 11C-choline in 13) between December 14th 2020 and March 10th 2021 following COVID-19 vaccination (Pfizer-BioNTech vaccine in 52, Moderna vaccine in 15) and who had undergone pre-vaccination PET without visible axillary node uptake. PET was performed a median of 13 and 10 days after vaccination in patients who had received one (n = 44) and two (n = 23) doses, respectively. Two nuclear medicine physicians independently reviewed images, blinded to injection laterality and days since vaccination. Lymph node or deltoid SUVmax greater than blood pool SUVmax was considered positive. Interreader agreement was assessed, and the more experienced physician's measurements were used for subsequent analysis. Results: Positive axillary lymph node uptake was observed in 10.4% (7/67) of patients [7.4% (4/54) of FDG examinations, 23.1% (3/13) of 11C-choline examinations]; four and three patients with positive axillary lymph nodes had received Pfizer and Moderna vaccines, respectively. Injection laterality was documented in five of seven patients with positive axillary lymph nodes and was ipsilateral to the positive node in all five patients. PET was performed within 24 days of vaccination in all patients with a positive node. One patient exhibited extra-axillary lymph node uptake (ipsilateral supraclavicular uptake on FDG PET). Ipsilateral deltoid uptake was present in 14.5% (8/55) of patients with documented injection laterality, including in 42.9% (3/7) of patients with positive axillary lymph nodes. Interreader agreement for SUV measurements ranged from intraclass correlation coefficient of 0.600 to 0.988. Conclusion: Increased axillary lymph node or ipsilateral deltoid uptake is occasionally observed on FDG or 11C-choline PET performed after Pfizer-BioNTech or Moderna COVID-19 vaccination. Clinical impact: Interpreting physicians should recognize characteristics of abnormal uptake on PET after COVID-19 vaccination to guide optimal follow-up management and reduce unnecessary biopsies.
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Cohen D, Hazut Krauthammer S, Cohen YC, Perry C, Avivi I, Herishanu Y, Even-Sapir E. Correlation between BNT162b2 mRNA Covid-19 vaccine-associated hypermetabolic lymphadenopathy and humoral immunity in patients with hematologic malignancy. Eur J Nucl Med Mol Imaging 2021; 48:3540-3549. [PMID: 33966088 PMCID: PMC8106512 DOI: 10.1007/s00259-021-05389-x] [Citation(s) in RCA: 32] [Impact Index Per Article: 10.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2021] [Accepted: 04/25/2021] [Indexed: 12/16/2022]
Abstract
Purpose Vaccine-associated hypermetabolic lymphadenopathy (VAHL) is frequently observed on [18F]FDG PET-CT following BNT162b2 administration. Recent data suggest a prominent B cell germinal-center (GC) response elicited by mRNA vaccines in draining lymph nodes. Thus, in this study we aimed to explore the correlation between VAHL and humoral immunity as reflected by post-vaccination serologic testing and by comparing the incidence of VAHL between lymphoma patients treated recently with B cell depleting therapy and those that were not. Methods A total of 137 patients with hematologic malignancy that had post-vaccination [18F]FDG PET-CT were included (All-PET group), 86 received both vaccine doses before imaging (PET-2 group). Their VAHL status and grade on imaging were recorded. Among 102 lymphoma patients, 34 (33.3%) were treated during the year prior vaccination with anti-CD20 antibody containing therapy. A subgroup of 54 patients also underwent serologic testing 2–3 weeks after the booster dose, and their anti-spike titers were recorded and graded as well. Results The overall incidence of VAHL in patients with hematologic malignancy was 31.4%. The 34 lymphoma patients treated during the year prior vaccination with anti-CD20 antibody containing therapy had significantly lower rates of VAHL comparted with all other lymphoma patients (8.8 versus 41.2% in all-PET patients, Pv < 0.01). VAHL rates were 10% in patients with negative serology, 31.3% in patients with low anti-spike titers, and 72.2% in patients with high anti-spike titers. The positive predictive values of VAHL were 90 and 93.3% in all-PET and PET-2 patients, respectively. A positive statistically significant correlation was found between VAHL and serology ranks in All-PET patients (rs = 0.530, Pv < 0.001), and stronger correlation was found in PET-2 patients (rs = 0.642, Pv < 0.001). Conclusion VAHL on [18F]FDG PET-CT of patients with hematologic malignancy may reflect GC B cell proliferation and an effective humoral response elicited by BNT162b2 vaccine.
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Affiliation(s)
- Dan Cohen
- Department of Nuclear Medicine, Tel-Aviv Sourasky Medical Center, 6 Weizmann St, 6423906, Tel Aviv, Israel
| | - Shir Hazut Krauthammer
- Department of Nuclear Medicine, Tel-Aviv Sourasky Medical Center, 6 Weizmann St, 6423906, Tel Aviv, Israel
| | - Yael C Cohen
- Institute of Hematology, Tel-Aviv Sourasky Medical Center, 6 Weizmann St, 6423906, Tel Aviv, Israel
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Chava Perry
- Institute of Hematology, Tel-Aviv Sourasky Medical Center, 6 Weizmann St, 6423906, Tel Aviv, Israel
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Irit Avivi
- Institute of Hematology, Tel-Aviv Sourasky Medical Center, 6 Weizmann St, 6423906, Tel Aviv, Israel
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Yair Herishanu
- Institute of Hematology, Tel-Aviv Sourasky Medical Center, 6 Weizmann St, 6423906, Tel Aviv, Israel
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Einat Even-Sapir
- Department of Nuclear Medicine, Tel-Aviv Sourasky Medical Center, 6 Weizmann St, 6423906, Tel Aviv, Israel.
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel.
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Barriere J, Bondouy M. COVID arm and PET/FDG imaging. Bull Cancer 2021; 108:668-669. [PMID: 33972089 PMCID: PMC8103193 DOI: 10.1016/j.bulcan.2021.04.002] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2021] [Revised: 04/12/2021] [Accepted: 04/26/2021] [Indexed: 11/15/2022]
Affiliation(s)
- Jérôme Barriere
- Medical Oncology Department, Polyclinique Saint-Jean, 92, avenue Dr Donat, 06800 Cagnes-Sur-Mer, France.
| | - Michaël Bondouy
- Hôpital Privé Arnault Tzanck, Nuclear Medecine Department, 122, avenue Maurice-Donat, 06250 Mougins, France
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Abstract
ABSTRACT Vaccinations can cause hypermetabolic axillary lymphadenopathy on FDG PET. We present the case of a 71-year-old man who underwent FDG PET/CT for melanoma staging 6 days following a COVID (coronavirus disease) vaccination. Imaging showed a prominent intramuscular mass at the vaccination site, in addition to extensive axillary lymphadenopathy. The mass was compatible with a hematoma at the vaccination site, and the lymphadenopathy was most likely reactive. This case demonstrates unconventional findings in response to a routine vaccination event-findings that, in light of current world events, are likely to be routinely encountered on PET imaging and that should be recognized reactive rather malignant.
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Affiliation(s)
- Saba Moghimi
- From the Department of Radiology, University of British Columbia
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Ahmed N, Muzaffar S, Binns C, Ilyas MW, Usmani S. COVID-19 Vaccination Manifesting as Incidental Lymph Nodal Uptake on 18F-FDG PET/CT. Clin Nucl Med 2021; 46:435-436. [PMID: 33661193 DOI: 10.1097/rlu.0000000000003635] [Citation(s) in RCA: 18] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
ABSTRACT Benign uptake on 18F-FDG PET can be seen with inflammatory conditions. We report a case of an 86-year-old woman with successfully treated nasal melanoma who underwent routine follow-up 18F-FDG PET, day 6 after the second dose of Pfizer-BioNTech COVID-19 vaccine inoculated in the left deltoid muscle. 18F-FDG PET showed increase tracer uptake in the left deltoid muscle and in 2 normal-sized left subpectoral nodes. These findings were considered secondary to vaccination. With the current drive of global COVID-19 immunization, this case highlights the importance of documenting vaccination history at the time of scanning to avoid false-positive results.
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Affiliation(s)
| | - Samreen Muzaffar
- From the Cancer Research Group, Hull York Medical School, University of Hull, Hull
| | - Corinne Binns
- Jack Brignall PET/CT Centre, Castle Hill Hospital, Cottingham, United Kingdom
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Abstract
ABSTRACT We present a case of increased FDG uptake in the lymph nodes after COVID-19 vaccine administration. Restaging PET/CT scan of a 70-year-old woman with a history of multiple relapsed Hodgkin lymphoma showed muscle activity in the left upper arm laterally, which is in the deep musculature of the left deltoid muscle. There was also increased activity in several normal-sized left axillary nodes as well. On further review of the patient's history, she had received her second shot of the Pfizer-BioNTech COVID-19 vaccine approximately 2 days before the restaging PET/CT scan.
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Affiliation(s)
- Mohan Doss
- From the Nuclear Medicine and PET Service, Department of Diagnostic Imaging
| | - Shazia K Nakhoda
- Department of Medical Oncology, Fox Chase Cancer Center, Philadelphia, PA
| | - Yi Li
- From the Nuclear Medicine and PET Service, Department of Diagnostic Imaging
| | - Jian Q Yu
- From the Nuclear Medicine and PET Service, Department of Diagnostic Imaging
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Shah S, Wagner T, Nathan M, Szyszko T. COVID-19 vaccine-related lymph node activation - patterns of uptake on PET-CT. BJR Case Rep 2021; 7:20210040. [PMID: 34131510 PMCID: PMC8171126 DOI: 10.1259/bjrcr.20210040] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2021] [Revised: 03/31/2021] [Accepted: 04/06/2021] [Indexed: 11/05/2022] Open
Abstract
In a bid to end the current COVID-19 crisis, many countries including UK have begun a mass immunization programme. Immunization can cause transient inflammation thereby causing increased metabolic activity at injection site and hypermetabolic lymph nodes. Various vaccinations and local injections have been known to cause diagnostic dilemma due to false-positive uptake on FDG PET-CT. In this pictorial case review, we present five cases demonstrating various patterns of uptake including an ipsilateral deltoid muscle, axillary, supraclavicular, and subpectoral lymph nodes post COVID-19 vaccination. A careful history of COVID-19 vaccination and normal size and morphology of lymph node on unenhanced low-dose CT will aid the diagnosis. All patients undergoing FDG PET-CT will require detailed documentation of the vaccination history including the time interval since vaccination. Knowledge about these patterns of uptake on PET-CT will ensure accurate interpretation by Nuclear Medicine physicians and radiologists during the current vaccination drive.
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Affiliation(s)
- Sweni Shah
- Department of Nuclear Medicine, Royal Free London NHS Foundation Trust, London, United Kingdom
| | - Thomas Wagner
- Department of Nuclear Medicine, Royal Free London NHS Foundation Trust, London, United Kingdom
| | - Malavika Nathan
- Department of Nuclear Medicine, Royal Free London NHS Foundation Trust, London, United Kingdom
| | - Teresa Szyszko
- Department of Nuclear Medicine, Royal Free London NHS Foundation Trust, London, United Kingdom
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