1
|
Yamanaka S, Tanaka K, Miyagawa M, Kido T, Hasebe S, Yamamoto S, Fujii T, Takeuchi K, Yakushijin Y. Distinguishing Axillary Lymphadenopathy after COVID-19 Vaccination from Malignant Lymphadenopathy. J Clin Med 2024; 13:3387. [PMID: 38929916 PMCID: PMC11205010 DOI: 10.3390/jcm13123387] [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: 04/16/2024] [Revised: 06/05/2024] [Accepted: 06/07/2024] [Indexed: 06/28/2024] Open
Abstract
Objectives: To study the differences between malignant hypermetabolic axillary lymphadenopathy (MHL) and COVID-19 vaccine-associated axillary hypermetabolic lymphadenopathy (VAHL) using clinical imaging. Methods: A total of 1096 patients underwent Positron Emission Tomography-Computed Tomography (PET-CT) between 1 June 2021 and 30 April 2022 at Ehime University Hospital. In total, 188 patients with axillary lymphadenopathy after the COVID-19 vaccination were evaluated. The patients were classified into three groups such as VAHL (n = 27), MHL (n = 21), and equivocal hypermetabolic axillary lymphadenopathy (EqHL; n = 140). Differences in lymph node (LN) swellings were statistically analyzed using clinical imaging (echography, CT, and 18F-FDG PET). Results: MHL included a higher female population (90.5%) owing to a higher frequency of breast cancer (80.9%). Axillary LNs of MHL did not show any LN fatty hilums (0%); however, those of VAHL and EqHL did (15.8 and 36%, respectively). After the logistic regression analysis of the patients who had axillary lymphadenopathy without any LN fatty hilums, the minor axis length and ellipticity (minor axis/major axis) in the largest axillary LN, SUVmax, and Tissue-to-Background Ratio (TBR) were useful in distinguishing malignant lymphadenopathies. A receiver-operating characteristic (ROC) analysis indicated that a cut-off value of ≥7.3 mm for the axillary LN minor axis (sensitivity: 0.714, specificity: 0.684) and of ≥0.671 for ellipticity (0.667 and 0.773, respectively) in the largest LN with the highest SUVmax and TBR were predictive of MHL. Conclusions: Axillary lymphadenopathy of the minor axis and ellipticity in LN without fatty hilums may be useful to be suspicious for malignancy, even in patients who have received COVID-19 vaccination. Further examinations, such as 18F-FDG PET, are recommended for such patients.
Collapse
Affiliation(s)
- Shintaro Yamanaka
- Department of Clinical Oncology, Ehime University Graduate School of Medicine, Toon 791-0295, Japan; (S.Y.); (S.H.); (S.Y.); (T.F.)
| | - Keiko Tanaka
- Department of Epidemiology and Public Health, Ehime University Graduate School of Medicine, Toon 791-0295, Japan;
| | - Masao Miyagawa
- Department of Radiology, Ehime University Graduate School of Medicine, Toon 791-0295, Japan; (M.M.); (T.K.)
| | - Teruhito Kido
- Department of Radiology, Ehime University Graduate School of Medicine, Toon 791-0295, Japan; (M.M.); (T.K.)
| | - Shinji Hasebe
- Department of Clinical Oncology, Ehime University Graduate School of Medicine, Toon 791-0295, Japan; (S.Y.); (S.H.); (S.Y.); (T.F.)
| | - Shoichiro Yamamoto
- Department of Clinical Oncology, Ehime University Graduate School of Medicine, Toon 791-0295, Japan; (S.Y.); (S.H.); (S.Y.); (T.F.)
| | - Tomomi Fujii
- Department of Clinical Oncology, Ehime University Graduate School of Medicine, Toon 791-0295, Japan; (S.Y.); (S.H.); (S.Y.); (T.F.)
| | - Kazuto Takeuchi
- Department of Clinical Laboratory, Ehime Prefectural University of Health Sciences, Tobe 791-2101, Japan;
| | - Yoshihiro Yakushijin
- Department of Clinical Oncology, Ehime University Graduate School of Medicine, Toon 791-0295, Japan; (S.Y.); (S.H.); (S.Y.); (T.F.)
| |
Collapse
|
2
|
Adin ME, Isufi E, Wu J, Pang Y, Nguyen D, Simsek Has D, Caner C, Aboueldaha N, Mossa-Basha M, Pucar D. Reactive axillary lymph nodes after COVID-19 mRNA vaccination: comparison of mRNA vs. attenuated whole-virus vaccines. Nucl Med Commun 2024; 45:474-480. [PMID: 38465449 DOI: 10.1097/mnm.0000000000001833] [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: 03/12/2024]
Abstract
OBJECTIVE To compare the incidence and natural course of reactive axillary lymph nodes (RAL) between mRNA and attenuated whole-virus vaccines using Deauville criteria. METHODS In this multi-institutional PET-CT study comprising multiple vaccine types (Pfizer-BioNTech/Comirnaty, Moderna/Spikevax, Sinovac/CoronaVac and Janssen vaccines), we evaluated the incidence and natural course of RAL in a large cohort of oncological patients utilizing a standardized Deauville scaling system (n=522; 293 Female, Deauville 3-5 positive for RAL). Univariate and multivariate analyses were conducted to evaluate the predictive value of clinical parameters (absolute neutrophil count [ANC], platelets, age, sex, tumor type, and vaccine-to-PET interval) for PET positivity. RESULTS Pfizer-BioNTech/Comirnaty and Moderna vaccines revealed similar RAL incidences for the first 20 days after the second dose of vaccine administration (44% for the first 10 days for both groups, 26% vs. 20% for 10-20 days, respectively for Moderna and Pfizer). However, Moderna recipients revealed significantly higher incidences of RAL after 20 days compared to Pfizer-BioNTech/Comirnaty, with nodal reactivity spanning up to the 9th week post-vaccination (15% vs. 4%, respectively P < 0.001). No RAL was observed in patients who received either a single dose of J&J vaccine or two doses of CroronaVac. Younger patients showed increased likelihood of RAL, otherwise, clinical/demographic parameters were not predictive of RAL ( P = 0.014 for age, P > 0.05 for additional clinical/demographic parameters). CONCLUSION RAL based on strict PET criteria was observed with mRNA but not with attenuated whole-virus vaccines, in line with higher immunogenicity and stronger protection offered by mRNA vaccines.
Collapse
Affiliation(s)
- Mehmet Emin Adin
- Department of Radiology and Biomedical Imaging, Yale School of Medicine, New Haven, Connecticut,
| | - Edvin Isufi
- Departments of Radiology, University of Missouri, Columbia, Missouri
| | - Jennifer Wu
- Department of Radiology and Biomedical Imaging, Yale School of Medicine, New Haven, Connecticut,
| | - Yulei Pang
- Department of Mathematics, Southern Connecticut State University, New Haven, Connecticut,
| | - Daniel Nguyen
- University of Massachusetts Chan Medical School, Worcester, Massachusetts, USA
| | - Duygu Simsek Has
- Department of Nuclear Medicine, Istanbul School of Medicine, Istanbul University, Istanbul, Turkey
| | - Civan Caner
- Department of Nuclear Medicine, Istanbul School of Medicine, Istanbul University, Istanbul, Turkey
| | - Noha Aboueldaha
- Department of Radiology, Washington University School of Medicine, Seattle, Washington and
| | - Mahmud Mossa-Basha
- Department of Radiology, Washington University School of Medicine, Seattle, Washington and
| | - Darko Pucar
- Departments of Radiology, Cleveland Clinic, Weston, Florida, USA
| |
Collapse
|
3
|
Takahashi K, Manabe O, Shizukuishi K, Shibata H, Kawakami H, Otsuka A, Oyama-Manabe N. Examination of iatrogenic FDG accumulation after COVID-19 vaccination. Ann Nucl Med 2024; 38:409-417. [PMID: 38563890 DOI: 10.1007/s12149-024-01909-5] [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: 08/22/2023] [Accepted: 01/23/2024] [Indexed: 04/04/2024]
Abstract
PURPOSE This study aimed to investigate the frequency of COVID-19 vaccine-induced reactive change and potential factors including blood type correlated with increased FDG uptake on positron emission tomography (PET)/computed tomography (CT). MATERIALS AND METHODS We evaluated 284 patients who underwent PET/CT between June and September 2021 and had a known history of COVID-19 vaccination. Information on the injection site, vaccine type, and adverse reactions was obtained. We visually assessed the presence or absence of accumulation in the axillary and supraclavicular lymph nodes and the deltoid muscles. We measured the maximum standardized uptake value (SUVmax) using semi-quantitative analysis. RESULTS Our study included 158 males and 126 females aged 16-94. The median time between vaccination and PET/CT was 9 and 42 days for patients who had received their first and second doses, respectively. We observed axillary lymph node accumulation, supraclavicular lymph node accumulation, and deltoid muscle accumulation in 98 (SUVmax 1.07-25.1), nine (SUVmax 2.28-14.5), and 33 cases (SUVmax 0.93-7.42), respectively. In cases with axillary lymph node (P = 0.0057) or deltoid muscle (P = 0.047) accumulation, the shorter the time since vaccination, the higher the FDG accumulation. Patients with axillary lymph node accumulation were significantly younger (P < 0.0001) and had a significantly higher frequency of adverse reactions such as fever (P < 0.0001) and myalgia (P = 0.002). No significant relationship was observed between blood type and the frequency of FDG accumulation. Logistic regression analysis also showed that age, gender, days since vaccination, and adverse reactions such as fever and myalgia were important factors for axillary lymph node accumulation. CONCLUSION Our study found that FDG accumulation in the axillary lymph nodes and deltoid muscle was higher within a shorter time after vaccination, and axillary lymph node accumulation was higher in young patients, females, and those with adverse reactions of fever and myalgia. No significant relationship was observed between blood type and the frequency of FDG accumulation. Confirming the vaccination status, time since vaccination, and the presence of adverse reactions before PET may reduce false positives.
Collapse
Affiliation(s)
- Keiko Takahashi
- Department of Radiology, Jichi Medical University Saitama Medical Center, 1-847 Amanuma-cho, Omiya-ku, Saitama, 330-8503, Japan
- Department of Radiology, Dokkyo Medical University Saitama Medical Center, Koshigaya, Japan
| | - Osamu Manabe
- Department of Radiology, Jichi Medical University Saitama Medical Center, 1-847 Amanuma-cho, Omiya-ku, Saitama, 330-8503, Japan.
| | | | | | - Hiroki Kawakami
- Central Division of Radiology, Jichi Medical University Saitama Medical Center, Saitama, Japan
| | - Akira Otsuka
- Central Division of Radiology, Jichi Medical University Saitama Medical Center, Saitama, Japan
| | - Noriko Oyama-Manabe
- Department of Radiology, Jichi Medical University Saitama Medical Center, 1-847 Amanuma-cho, Omiya-ku, Saitama, 330-8503, Japan
| |
Collapse
|
4
|
Chiang MT, Wang JT, Lin WY, Yen RF, Huang JY, Lu CC. Comparison of post-COVID-19 vaccination hypermetabolic lymphadenopathy on 18F-fluorodeoxyglucose PET/CT between virus-vector vaccine and mRNA vaccine. Eur J Med Res 2023; 28:513. [PMID: 37964395 PMCID: PMC10647177 DOI: 10.1186/s40001-023-01456-1] [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: 12/19/2022] [Accepted: 10/18/2023] [Indexed: 11/16/2023] Open
Abstract
PURPOSE We compared hypermetabolic lymphadenopathy (HLN) on 18F-fluorodeoxyglucose (FDG) positron emission tomography (PET)/computed tomography (CT) after virus-vector and mRNA vaccines for coronavirus disease 2019 (COVID-19). METHODS This retrospective study included 573 participants who underwent FDG PET/CT after receiving a virus-vector vaccine (ChAdOx1, AstraZeneca [AZ] group) or an mRNA vaccine (mRNA-1273, Moderna [M] group) from July 2021 to October 2021. The incidence and avidity of HLN were evaluated and correlated with clinical features and vaccine type. The final analysis was conducted with 263 participants in the AZ group and 310 participants in the M group. RESULTS The HLN incidence was significantly lower in the AZ group than in the M group (38/263 [14%] vs. 74/310 [24%], p = 0.006). The FDG avidity of HLN was comparable between the two groups. The HLN incidence in both groups was significantly higher within 4 weeks after the vaccination compared with more than 4 weeks. The HLN incidence within 4 weeks of the vaccination was significantly higher in the M group than in the AZ group (p = 0.008), whereas a difference in HLN incidence between the two groups was not observed after the same duration (p = 0.11). CONCLUSIONS The mRNA mRNA-1273 COVID-19 vaccine was found to be associated with higher glucose hypermetabolism in regional lymph nodes within the first 4 weeks compared with the virus-vector vaccine, as indicated by the presence of HLN on FDG PET/CT. The degree of glucose hypermetabolism was comparable between the two vaccines.
Collapse
Affiliation(s)
- Meng-Ting Chiang
- Department of Nuclear Medicine, National Taiwan University Hospital, No. 7, Zhongshan S. Rd., Zhongzheng Dist., Taipei City, Taiwan
| | - Jann-Tay Wang
- Department of Internal Medicine, National Taiwan University Hospital, Taipei, Taiwan
| | - Wan-Yu Lin
- Institute of Health Data Analytics and Statistics, College of Public Health, National Taiwan University, Taipei, Taiwan
| | - Ruoh-Fang Yen
- Department of Nuclear Medicine, National Taiwan University Hospital, No. 7, Zhongshan S. Rd., Zhongzheng Dist., Taipei City, Taiwan
| | - Jei-Yie Huang
- Department of Nuclear Medicine, National Taiwan University Hospital, No. 7, Zhongshan S. Rd., Zhongzheng Dist., Taipei City, Taiwan
| | - Ching-Chu Lu
- Department of Nuclear Medicine, National Taiwan University Hospital, No. 7, Zhongshan S. Rd., Zhongzheng Dist., Taipei City, Taiwan.
| |
Collapse
|
5
|
Kim HJ, Lee SJ, Sa S, Bae JH, Song G, Lee CW, Kim JH, Shim SR, Hong M, Han HW. Safety of COVID-19 Vaccines among Patients with Type 2 Diabetes Mellitus: Real-World Data Analysis. Diabetes Metab J 2023; 47:356-365. [PMID: 36872064 PMCID: PMC10244203 DOI: 10.4093/dmj.2022.0129] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/11/2022] [Accepted: 08/04/2022] [Indexed: 03/07/2023] Open
Abstract
BACKGROUND Little is known about the adverse events (AEs) associated with coronavirus disease 2019 (COVID-19) vaccination in patients with type 2 diabetes mellitus (T2DM). METHODS This study used vaccine AE reporting system data to investigate severe AEs among vaccinated patients with T2DM. A natural language processing algorithm was applied to identify people with and without diabetes. After 1:3 matching, we collected data for 6,829 patients with T2DM and 20,487 healthy controls. Multiple logistic regression analysis was used to calculate the odds ratio for severe AEs. RESULTS After COVID-19 vaccination, patients with T2DM were more likely to experience eight severe AEs than controls: cerebral venous sinus thrombosis, encephalitis myelitis encephalomyelitis, Bell's palsy, lymphadenopathy, ischemic stroke, deep vein thrombosis (DVT), thrombocytopenia (TP), and pulmonary embolism (PE). Moreover, patients with T2DM vaccinated with BNT162b2 and mRNA-1273 were more vulnerable to DVT and TP than those vaccinated with JNJ-78436735. Among patients with T2DM administered mRNA vaccines, mRNA-1273 was safer than BNT162b2 in terms of the risk of DVT and PE. CONCLUSION Careful monitoring of severe AEs in patients with T2DM may be necessary, especially for those related to thrombotic events and neurological dysfunctions after COVID-19 vaccination.
Collapse
Affiliation(s)
- Hye Jun Kim
- Department of Biomedical Informatics, CHA University School of Medicine, Seongnam,
Korea
- Institute of Basic Medical Sciences, CHA University School of Medicine, Seongnam,
Korea
- Institute for Biomedical Informatics, CHA University School of Medicine, Seongnam,
Korea
| | - Sang Jun Lee
- Department of Biomedical Informatics, CHA University School of Medicine, Seongnam,
Korea
- Institute of Basic Medical Sciences, CHA University School of Medicine, Seongnam,
Korea
- Institute for Biomedical Informatics, CHA University School of Medicine, Seongnam,
Korea
| | - Soonok Sa
- Department of Biomedical Informatics, CHA University School of Medicine, Seongnam,
Korea
- Institute of Basic Medical Sciences, CHA University School of Medicine, Seongnam,
Korea
- Institute for Biomedical Informatics, CHA University School of Medicine, Seongnam,
Korea
| | - Jung Ho Bae
- Department of Internal Medicine and Healthcare Research Institute, Seoul National University Hospital Healthcare System Gangnam Center, Seoul,
Korea
| | - Gyuseon Song
- Department of Biomedical Informatics, CHA University School of Medicine, Seongnam,
Korea
- Institute of Basic Medical Sciences, CHA University School of Medicine, Seongnam,
Korea
- Institute for Biomedical Informatics, CHA University School of Medicine, Seongnam,
Korea
| | - Chae Won Lee
- Department of Biomedical Informatics, CHA University School of Medicine, Seongnam,
Korea
- Institute of Basic Medical Sciences, CHA University School of Medicine, Seongnam,
Korea
- Institute for Biomedical Informatics, CHA University School of Medicine, Seongnam,
Korea
| | - Ju Hee Kim
- Department of Biomedical Informatics, CHA University School of Medicine, Seongnam,
Korea
- Institute of Basic Medical Sciences, CHA University School of Medicine, Seongnam,
Korea
- Institute for Biomedical Informatics, CHA University School of Medicine, Seongnam,
Korea
| | - Sung Ryul Shim
- Department of Biomedical Informatics, CHA University School of Medicine, Seongnam,
Korea
- Institute of Basic Medical Sciences, CHA University School of Medicine, Seongnam,
Korea
- Institute for Biomedical Informatics, CHA University School of Medicine, Seongnam,
Korea
- Department of Health and Medical Informatics, Kyungnam University College of Health Sciences, Changwon,
Korea
| | - Myunghee Hong
- Department of Biomedical Informatics, CHA University School of Medicine, Seongnam,
Korea
- Institute of Basic Medical Sciences, CHA University School of Medicine, Seongnam,
Korea
- Institute for Biomedical Informatics, CHA University School of Medicine, Seongnam,
Korea
| | - Hyun Wook Han
- Department of Biomedical Informatics, CHA University School of Medicine, Seongnam,
Korea
- Institute of Basic Medical Sciences, CHA University School of Medicine, Seongnam,
Korea
- Institute for Biomedical Informatics, CHA University School of Medicine, Seongnam,
Korea
| |
Collapse
|
6
|
Ho TC, Shen DHY, Chang CC, Chan HP, Chuang KP, Yuan CH, Chen CN, Yang MH, Tyan YC. Immune Response Related to Lymphadenopathy Post COVID-19 Vaccination. Vaccines (Basel) 2023; 11:vaccines11030696. [PMID: 36992280 DOI: 10.3390/vaccines11030696] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2023] [Revised: 03/15/2023] [Accepted: 03/15/2023] [Indexed: 03/31/2023] Open
Abstract
Mass vaccination against coronavirus disease 2019 (COVID-19) is a global health strategy to control the COVID-19 pandemic. With the increasing number of vaccinations, COVID-19 vaccine-associated lymphadenopathy (C19-VAL) has been frequently reported. Current findings emphasize the characteristics of C19-VAL. The mechanism of C19-VAL is complicated to explore. Accumulated reports separately show that C19-VAL incidence is associated with receiver age and gender, reactive change within lymph nodes (LN), etc. We constructed a systematic review to evaluate the associated elements of C19-VAL and provide the mechanism of C19-VAL. Articles were searched from PubMed, Web of Science and EMBASE by using the processing of PRISMA. The search terms included combinations of the COVID-19 vaccine, COVID-19 vaccination and lymphadenopathy. Finally, sixty-two articles have been included in this study. Our results show that days post-vaccination and B cell germinal center response are negatively correlated with C19-VAL incidence. The reactive change within LN is highly related to C19-VAL development. The study results suggested that strong vaccine immune response may contribute to the C19-VAL development and perhaps through the B cell germinal center response post vaccination. From the perspective of imaging interpretation, it is important to carefully distinguish reactive lymph nodes from metastatic lymph node enlargement through medical history collection or evaluation, especially in patients with underlying malignancy.
Collapse
Affiliation(s)
- Tzu-Chuan Ho
- Department of Medical Imaging and Radiological Sciences, Kaohsiung Medical University, Kaohsiung 807, Taiwan
| | - Daniel Hueng-Yuan Shen
- Department of Nuclear Medicine, Kaohsiung Veterans General Hospital, Kaohsiung 813, Taiwan
| | - Chin-Chuan Chang
- Department of Nuclear Medicine, Kaohsiung Medical University Hospital, Kaohsiung 807, Taiwan
- School of Medicine, Kaohsiung Medical University, Kaohsiung 807, Taiwan
- Neuroscience Research Center, Kaohsiung Medical University, Kaohsiung 807, Taiwan
- Department of Electrical Engineering, I-Shou University, Kaohsiung 840, Taiwan
| | - Hung-Pin Chan
- Department of Nuclear Medicine, Kaohsiung Veterans General Hospital, Kaohsiung 813, Taiwan
| | - Kuo-Pin Chuang
- Graduate Institute of Animal Vaccine Technology, College of Veterinary Medicine, National Pingtung University of Science and Technology, Pingtung 912, Taiwan
| | - Cheng-Hui Yuan
- Mass Spectrometry Laboratory, Department of Chemistry, National University of Singapore, Singapore 119077, Singapore
| | - Ciao-Ning Chen
- Department of Medical Imaging and Radiological Sciences, Kaohsiung Medical University, Kaohsiung 807, Taiwan
| | - Ming-Hui Yang
- Department of Medical Education and Research, Kaohsiung Veterans General Hospital, Kaohsiung 813, Taiwan
- Center of General Education, Shu-Zen Junior College of Medicine and Management, Kaohsiung 821, Taiwan
| | - Yu-Chang Tyan
- Department of Medical Imaging and Radiological Sciences, Kaohsiung Medical University, Kaohsiung 807, Taiwan
- Graduate Institute of Animal Vaccine Technology, College of Veterinary Medicine, National Pingtung University of Science and Technology, Pingtung 912, Taiwan
- Research Center for Precision Environmental Medicine, Kaohsiung Medical University, Kaohsiung 807, Taiwan
- Department of Medical Research, Kaohsiung Medical University Hospital, Kaohsiung 807, Taiwan
- Center for Tropical Medicine and Infectious Disease Research, Kaohsiung Medical University, Kaohsiung 807, Taiwan
| |
Collapse
|
7
|
Paquin AR, Oyogoa E, McMurry HS, Kartika T, West M, Shatzel JJ. The diagnosis and management of suspected lymphoma in general practice. Eur J Haematol 2023; 110:3-13. [PMID: 36093749 PMCID: PMC10042228 DOI: 10.1111/ejh.13863] [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: 05/18/2022] [Revised: 08/26/2022] [Accepted: 08/29/2022] [Indexed: 11/28/2022]
Abstract
With rapid advancements in diagnosis and treatment of malignancies, the gap between generalists and subspecialists continues to widen, particularly in cancers like lymphoma where the spectrum of disease varies from indolent to rapidly progressive. Prior to establishing with a hematologist/oncologist, patients must be accurately and comprehensively diagnosed and managed for lymphoma in the generalist setting. In the following manuscript, we review the common clinical presentations in which should raise concern for lymphoma. We summarize the literature regarding the role of laboratory studies including complete blood count and peripheral blood flow cytometry, the recommendations for lymph node sampling, the role and selection of imaging modalities, and ideal patient monitoring for high-risk clinical syndromes that may be encountered in lymphoma.
Collapse
Affiliation(s)
- Ashley R. Paquin
- Division of Internal Medicine, Oregon Health and Science University, Portland, Oregon, USA
| | - Emmanuella Oyogoa
- Division of Internal Medicine, Oregon Health and Science University, Portland, Oregon, USA
| | - Hannah Stowe McMurry
- Division of Internal Medicine, Oregon Health and Science University, Portland, Oregon, USA
| | - Thomas Kartika
- Division of Hematology and Medical Oncology, School of Medicine, Oregon Health and Science University, Portland, Oregon, USA
| | - Malinda West
- Division of Hematology and Medical Oncology, School of Medicine, Oregon Health and Science University, Portland, Oregon, USA
| | - Joseph J. Shatzel
- Division of Hematology and Medical Oncology, School of Medicine, Oregon Health and Science University, Portland, Oregon, USA
- Department of Biomedical Engineering, Oregon Health and Science University, Portland, Oregon, USA
| |
Collapse
|
8
|
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.
Collapse
|
9
|
Mohseni Afshar Z, Tavakoli Pirzaman A, Liang JJ, Sharma A, Pirzadeh M, Babazadeh A, Hashemi E, Deravi N, Abdi S, Allahgholipour A, Hosseinzadeh R, Vaziri Z, Sio TT, Sullman MJM, Barary M, Ebrahimpour S. Do we miss rare adverse events induced by COVID-19 vaccination? Front Med (Lausanne) 2022; 9:933914. [PMID: 36300183 PMCID: PMC9589063 DOI: 10.3389/fmed.2022.933914] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2022] [Accepted: 09/13/2022] [Indexed: 11/13/2022] Open
Abstract
Although severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection has caused many complications, the invention of coronavirus disease 2019 (COVID-19) vaccines has also brought about several adverse events, from common side effects to unexpected and rare ones. Common vaccine-related adverse reactions manifest locally or systematically following any vaccine, including COVID-19 vaccines. Specific side effects, known as adverse events of particular interest (AESI), are unusual and need more evaluation. Here, we discuss some of the most critical rare adverse events of COVID-19 vaccines.
Collapse
Affiliation(s)
- Zeinab Mohseni Afshar
- Clinical Research Development Center, Imam Reza Hospital, Kermanshah University of Medical Sciences, Kermanshah, Iran
| | | | - Jackson J. Liang
- Division of Cardiovascular Medicine, Cardiac Arrhythmia Service, University of Michigan, Ann Arbor, MI, United States
| | - Akanksha Sharma
- Department of Neurology, Mayo Clinic, Scottsdale, AZ, United States
| | - Marzieh Pirzadeh
- Student Research Committee, Babol University of Medical Sciences, Babol, Iran
| | - Arefeh Babazadeh
- Infectious Diseases and Tropical Medicine Research Center, Health Research Institute, Babol University of Medical Sciences, Babol, Iran
| | - Erfan Hashemi
- Student Research Committee, Babol University of Medical Sciences, Babol, Iran
| | - Niloofar Deravi
- Student Research Committee, School of Medicine, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Sadaf Abdi
- Student Research Committee, Babol University of Medical Sciences, Babol, Iran
| | - Amirreza Allahgholipour
- Student Research Committee, School of Nursing and Midwifery, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Rezvan Hosseinzadeh
- Student Research Committee, Babol University of Medical Sciences, Babol, Iran
| | - Zahra Vaziri
- Student Research Committee, Babol University of Medical Sciences, Babol, Iran
| | - Terence T. Sio
- Department of Radiation Oncology, Mayo Clinic, Phoenix, AZ, United States
| | - Mark J. M. Sullman
- Department of Social Sciences, University of Nicosia, Nicosia, Cyprus
- Department of Life and Health Sciences, University of Nicosia, Nicosia, Cyprus
| | - Mohammad Barary
- Student Research Committee, Virtual School of Medical Education and Management, Shahid Beheshti University of Medical Sciences, Tehran, Iran
- Students' Scientific Research Center (SSRC), Tehran University of Medical Sciences, Tehran, Iran
| | - Soheil Ebrahimpour
- Infectious Diseases and Tropical Medicine Research Center, Health Research Institute, Babol University of Medical Sciences, Babol, Iran
| |
Collapse
|
10
|
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.
Collapse
|
11
|
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.
Collapse
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
| |
Collapse
|
12
|
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.
Collapse
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
| |
Collapse
|
13
|
Ashoor A, Shephard J, Lissidini G, Nicosia L. Response to Letter; Discrimination between Benign and Malignant Post-SARS-CoV-2 Vaccination Lymphadenopathy is Feasible, to Our Article; Axillary Adenopathy in Patients with Recent COVID-19 Vaccination: A New Diagnostic Dilemma. Korean J Radiol 2022; 23:775-776. [PMID: 35695318 PMCID: PMC9240295 DOI: 10.3348/kjr.2022.0207] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2022] [Accepted: 03/28/2022] [Indexed: 11/19/2022] Open
Affiliation(s)
- Arwa Ashoor
- Department of Breast Surgery, Sandwell and West Birmingham NHS Trust, City Hospital Birmingham, Birmingham, United Kingdom.
| | - Julie Shephard
- Department of Breast Radiology, Sandwell and West Birmingham NHS Trust, City Hospital Birmingham, Birmingham, United Kingdom
| | - Germana Lissidini
- Division of Breast Surgery, European Institute of Oncology, IRCCS, Milan, Italy
| | - Luca Nicosia
- Division of Breast Radiology, European Institute of Oncology, IRCCS, Milan, Italy
| |
Collapse
|
14
|
Finsterer J. Discrimination between Benign and Malignant Post-SARS-CoV-2 Vaccination Lymphadenopathy is Feasible. Korean J Radiol 2022; 23:773-774. [PMID: 35695321 PMCID: PMC9240297 DOI: 10.3348/kjr.2022.0110] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2022] [Accepted: 03/28/2022] [Indexed: 11/15/2022] Open
|
15
|
Yu Q, Jiang W, Chen N, Li J, Wang X, Li M, Wang D, Jiang L. Misdiagnosis of Reactive Lymphadenopathy Remotely After COVID-19 Vaccination: A Case Report and Literature Review. Front Immunol 2022; 13:875637. [PMID: 35812390 PMCID: PMC9259802 DOI: 10.3389/fimmu.2022.875637] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2022] [Accepted: 05/20/2022] [Indexed: 12/02/2022] Open
Affiliation(s)
- Qian Yu
- Department of Ultrasound, First Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Wei Jiang
- Department of Orthopaedics, First Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Ni Chen
- Department of Ultrasound, First Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Jia Li
- Department of Radiology, The First Affiliated Hospital, Chongqing Medical University, Chongqing, China
| | - Xiaohui Wang
- Department of Respiratory and Critical Care Medicine, First Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Maoping Li
- Department of Ultrasound, First Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Dong Wang
- Department of Ultrasound, First Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Lan Jiang
- Department of Ultrasound, First Affiliated Hospital of Chongqing Medical University, Chongqing, China
- *Correspondence: Lan Jiang,
| |
Collapse
|
16
|
Kashiwada T, Saito Y, Terasaki Y, Shirakura Y, Shinbu K, Tanaka T, Tanaka Y, Seike M, Gemma A. Kikuchi-Fujimoto disease can present as delayed lymphadenopathy after COVID-19 vaccination. Hum Vaccin Immunother 2022; 18:2071080. [PMID: 35583472 PMCID: PMC9481093 DOI: 10.1080/21645515.2022.2071080] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Abstract
Following COVID-19 vaccination, ipsilateral axillary and cervical lymphadenopathy may occur, called vaccine-related hypermetabolic lymphadenopathy, which is considered reactive lymphadenopathy. We report here a case of Kikuchi-Fujimoto disease, which occurred three months after vaccination with COVID-19 vaccine. The patient had cervical and axillary lymph node enlargement and a short-term fever that resolved spontaneously after the first and second vaccines. On the 90th day after the first vaccination, the patient developed a high fever and pathologically diagnosed necrotizing lymphadenitis in the axilla, which was diagnosed as Kikuchi-Fujimoto disease. Gallium scintigraphy showed localized swelling and strong uptake in the ipsilateral axilla. It implies the possibility of Kikuchi-Fujimoto Disease in axillary drainage lymph nodes in association with COVID-19 vaccine. Although only a few cases have been reported so far, this case is novel because of its later onset and diagnosis based on pathological and gallium scintigraphy imaging findings.
Collapse
Affiliation(s)
- Takeru Kashiwada
- Department of Pulmonary Medicine and Oncology, Graduate School of Medicine, Nippon Medical School, Tokyo, Japan
| | - Yoshinobu Saito
- Department of Pulmonary Medicine and Oncology, Graduate School of Medicine, Nippon Medical School, Tokyo, Japan
| | - Yasuhiro Terasaki
- Department of Analytic Human Pathology, Graduate School of Medicine, Nippon Medical School, Tokyo, Japan
| | - Yukari Shirakura
- Department of Pulmonary Medicine and Oncology, Graduate School of Medicine, Nippon Medical School, Tokyo, Japan
| | - Kaoruko Shinbu
- Department of Pulmonary Medicine and Oncology, Graduate School of Medicine, Nippon Medical School, Tokyo, Japan
| | - Toru Tanaka
- Department of Pulmonary Medicine and Oncology, Graduate School of Medicine, Nippon Medical School, Tokyo, Japan
| | - Yosuke Tanaka
- Department of Pulmonary Medicine and Oncology, Graduate School of Medicine, Nippon Medical School, Tokyo, Japan
| | - Masahiro Seike
- Department of Pulmonary Medicine and Oncology, Graduate School of Medicine, Nippon Medical School, Tokyo, Japan
| | - Akihiko Gemma
- Department of Pulmonary Medicine and Oncology, Graduate School of Medicine, Nippon Medical School, Tokyo, Japan
| |
Collapse
|
17
|
Yoshimoto N, Yanagi A, Takayama S, Sakamoto M, Tomoda K, Ishikawa K, Takura K, Kawate A, Takayama S, Yamashita M, Yamamoto S, Yokoyama K, Kani H. Timing and Duration of Axillary Lymph Node Swelling After COVID-19 Vaccination: Japanese Case Report and Literature Review. In Vivo 2022; 36:1333-1336. [PMID: 35478125 PMCID: PMC9087108 DOI: 10.21873/invivo.12834] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2022] [Revised: 02/22/2022] [Accepted: 02/23/2022] [Indexed: 11/10/2022]
Abstract
BACKGROUND/AIM COVID-19 vaccination is now performed in most of the world to limit the spread of the disease. The first mRNA vaccine was approved in clinical settings and has specific side effects including axillary lymph node swelling, which can be misdiagnosed as breast cancer metastasis. The timing of axillary lymph node swelling and its duration are unclear. Here, we present a Japanese case and review of the existing literature. CASE REPORT We report the case of a 67-year-old woman with breast calcification. She had regular follow ups in our hospital for this calcification and received ultrasonography of the breast and axilla at every visit. She visited 6 months before having her COVID-19 vaccination, and 7 days and 6 months after the first COVID-19 vaccination. She had a swollen axillary lymph node 7 days after the first vaccination, which although it was improved, remained for 6 months. CONCLUSION Axillary lymph node swelling occurred 7 days after vaccination and remained up to 6 months after it.
Collapse
Affiliation(s)
- Nobuyasu Yoshimoto
- Department of Breast Surgery, Nagoya Tokushukai General Hospital, Kasugai, Japan
- Clinical Research Center, Nagoya Tokushukai General Hospital, Kasugai, Japan
| | - Akemi Yanagi
- Department of Radiology, Nagoya Tokushukai General Hospital, Kasugai, Japan
| | - Satoru Takayama
- Department of Surgery, Nagoya Tokushukai General Hospital, Kasugai, Japan
| | - Masaki Sakamoto
- Department of Surgery, Nagoya Tokushukai General Hospital, Kasugai, Japan
| | - Keisuke Tomoda
- Department of Surgery, Nagoya Tokushukai General Hospital, Kasugai, Japan
| | - Ken Ishikawa
- Department of Surgery, Nagoya Tokushukai General Hospital, Kasugai, Japan
| | - Kohei Takura
- Department of Surgery, Nagoya Tokushukai General Hospital, Kasugai, Japan
| | - Akifumi Kawate
- Department of Surgery, Nagoya Tokushukai General Hospital, Kasugai, Japan
| | - Shoryu Takayama
- Department of Surgery, Nagoya Tokushukai General Hospital, Kasugai, Japan
| | | | - Shinya Yamamoto
- Department of Surgery, Nagoya Tokushukai General Hospital, Kasugai, Japan
| | - Kioto Yokoyama
- Department of Surgery, Nagoya Tokushukai General Hospital, Kasugai, Japan
| | - Hisanori Kani
- Department of Surgery, Nagoya Tokushukai General Hospital, Kasugai, Japan
| |
Collapse
|
18
|
COVID-19 Vaccination and Subclinical Axillary Lymphadenopathy on Mammogram: Correspondence. Acad Radiol 2022; 29:633. [PMID: 35058134 PMCID: PMC8710395 DOI: 10.1016/j.acra.2021.12.024] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2021] [Revised: 12/17/2021] [Accepted: 12/22/2021] [Indexed: 12/02/2022]
|
19
|
Emmanuel A, Phillips G. Seeing what others see while thinking what others have not. Clin Med (Lond) 2021; 21:e559-e560. [PMID: 34862212 DOI: 10.7861/clinmed.ed.21.6.1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Affiliation(s)
| | - Gerrard Phillips
- Federation of Royal Colleges of Physicians, London, UK and Dorset County Hospital, Dorchester, UK
| |
Collapse
|