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Open accessJournal ArticleDOI: 10.1016/J.JACR.2021.03.001

Unilateral Lymphadenopathy After COVID-19 Vaccination: A Practical Management Plan for Radiologists Across Specialties.

04 Mar 2021-Journal of The American College of Radiology (Elsevier)-Vol. 18, Iss: 6, pp 843-852
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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Topics: Axillary Lymphadenopathy (55%), Population (51%), Vaccination (50%)

23 results found

Open accessJournal ArticleDOI: 10.1016/J.ACRA.2021.04.007
01 May 2021-Academic Radiology
Abstract: RATIONALE AND OBJECTIVES: Despite all the benefits and effectiveness of the coronavirus disease 2019 (COVID-19) vaccines mentioned in recent clinical trials, some post-vaccination side effects such as lymphadenopathy (LAP) were observed. The present study reviewed all studies with imaging findings presentation of LAP after COVID-19 vaccination. MATERIALS AND METHODS: We conducted a literature search in online databases, including Scopus, Medline (PubMed), Web of Science, Embase (Elsevier), Cochrane library, and Google Scholar. RESULTS: A total of 19 studies (68 cases), including 60 (88.2%) females and eight (11.8%) males with a presentation of LAP after COVID-19 vaccination, were reviewed. LAP was identified after first or second dosages of three types of COVID-19 vaccines, including Pfizer-BioNTech (n = 30, 44.1%), Moderna (n = 17, 25%), and Oxford-AstraZeneca (n = 1, 1.5%). In 20 (29.4%) cases, vaccine type was not reported or only reported as mRNA COVID-19 vaccine. The median days of LAP presentation after the first and second dosages of COVID-19 vaccination, were 12 and 5 days, respectively. Most of the LAP imaging findings related to COVID-19 vaccination (n = 66, 97%) were seen from first day to 4 weeks after vaccination. However, LAP remained after 5 and 6 weeks of the first and second dosages of COVID-19 vaccination with decreased lymph nodes' size and residual cortical thickening in two cases. CONCLUSION: This review study of cases with LAP-associated COVID-19 vaccination guides radiologists and physicians to rely on patient's clinical context and updated resources to prevent potential disease upstaging and change in therapy.

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Topics: Vaccination (52%)

13 Citations

Open accessJournal ArticleDOI: 10.1148/RYCAN.2021210038
Wendy Tu1, David S. Gierada2, Bonnie N. Joe3Institutions (3)
09 Apr 2021-

11 Citations

Open accessJournal ArticleDOI: 10.1016/J.CRAD.2021.04.010
Adam Brown1, S. Shah1, Sam Dluzewski1, Besma Musaddaq1  +6 moreInstitutions (3)
14 May 2021-Clinical Radiology
Abstract: We present a multimodality pictorial review of axillary lymphadenopathy in patients recently vaccinated against COVID-19. As the mass vaccination programme continues to be rolled out worldwide in an effort to combat the pandemic, it is important that radiologists consider recent COVID-19 vaccination in the differential diagnosis of unilateral axillary lymphadenopathy and are aware of typical appearances across all imaging methods. We review current guidelines on the management of unilateral axillary lymphadenopathy in the context of recent COVID-19 vaccination.

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Topics: Axillary Lymphadenopathy (70%)

3 Citations

Open accessJournal ArticleDOI: 10.1016/J.ACRA.2021.06.003
10 Jun 2021-Academic Radiology
Abstract: Introduction Following vaccination of Israeli population with Pfizer-BioNTech COVID-19 Vaccine, an unusual increase in axillary-lymphadenopathy was noted. This study assesses the rate and magnitude of this trend from breast-imaging standpoint. Materials and methods Participants undergoing breast-imaging, in whom isolated axillary-lymphadenopathy was detected were questioned regarding SARS-CoV-2 vaccine to the ipsilateral arm. Patients' and imaging characteristics were statistically compared. In order to perform a very short-term follow-up, twelve healthy vaccinated medical staff-members, underwent axillary-ultrasound shortly after the second dose, and follow-up. Results Axillary-lymphadenopathy attributed to vaccination was found in 163 women undergoing breast-imaging, including BRCA-carriers. During the study, number of detected lymphadenopathies increased by 394% (p = 0.00001) in comparison with previous 2 consecutive years. Mean cortical-thickness of abnormal lymph-nodes after second dose vaccination was 5 ± 2 mm. Longer lymph-node diameter after second vaccination was noted (from 15 ± 5 mm, to 18 ± 6 mm, p = 0.005). In the subgroup of medical staff members, following trends were observed: in patients with positive antibodies, lymph-node cortical-thickness was larger than patients with negative serology (p = 0.03); lymph-node cortical-thickness decreased in 4-5 weeks follow-up (p = 0.007). Lymphadenopathy was evident on mammography in only 49% of cases. Discussion Vaccine-associated lymphadenopathy is an important phenomenon with great impact on breast-imaging clinic workload. Results suggest the appearance of cortical thickening shortly after both doses. Positive serology is associated with increased lymph-node cortical-thickness. In asymptomatic vaccinated women with ipsilateral axillary-lymphadenopathy as the only abnormal finding, radiological follow-up is probably not indicated. BRCA-carriers, although at higher risk for breast-cancer, should probably receive the same management as average-risk patients.

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Topics: Population (52%)

3 Citations


25 results found

Open accessJournal ArticleDOI: 10.1056/NEJMOA1102873
Abstract: Background The aggressive and heterogeneous nature of lung cancer has thwarted efforts to reduce mortality from this cancer through the use of screening. The advent of low-dose helical computed tomography (CT) altered the landscape of lung-cancer screening, with studies indicating that low-dose CT detects many tumors at early stages. The National Lung Screening Trial (NLST) was conducted to determine whether screening with low-dose CT could reduce mortality from lung cancer. Methods From August 2002 through April 2004, we enrolled 53,454 persons at high risk for lung cancer at 33 U.S. medical centers. Participants were randomly assigned to undergo three annual screenings with either low-dose CT (26,722 participants) or single-view posteroanterior chest radiography (26,732). Data were collected on cases of lung cancer and deaths from lung cancer that occurred through December 31, 2009. Results The rate of adherence to screening was more than 90%. The rate of positive screening tests was 24.2% with low-dose CT and 6.9% with radiography over all three rounds. A total of 96.4% of the positive screening results in the low-dose CT group and 94.5% in the radiography group were false positive results. The incidence of lung cancer was 645 cases per 100,000 person-years (1060 cancers) in the low-dose CT group, as compared with 572 cases per 100,000 person-years (941 cancers) in the radiography group (rate ratio, 1.13; 95% confidence interval [CI], 1.03 to 1.23). There were 247 deaths from lung cancer per 100,000 person-years in the low-dose CT group and 309 deaths per 100,000 person-years in the radiography group, representing a relative reduction in mortality from lung cancer with low-dose CT screening of 20.0% (95% CI, 6.8 to 26.7; P=0.004). The rate of death from any cause was reduced in the low-dose CT group, as compared with the radiography group, by 6.7% (95% CI, 1.2 to 13.6; P=0.02). Conclusions Screening with the use of low-dose CT reduces mortality from lung cancer. (Funded by the National Cancer Institute; National Lung Screening Trial number, NCT00047385.).

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Topics: National Lung Screening Trial (72%), Lung cancer screening (71%), Lung cancer (59%) ... read more

6,212 Citations

Open accessJournal ArticleDOI: 10.1056/NEJMOA2034577
Abstract: Background Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection and the resulting coronavirus disease 2019 (Covid-19) have afflicted tens of millions of people in a world...

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4,222 Citations

Open accessJournal ArticleDOI: 10.1056/NEJMOA2035389
Abstract: Background Vaccines are needed to prevent coronavirus disease 2019 (Covid-19) and to protect persons who are at high risk for complications. The mRNA-1273 vaccine is a lipid nanoparticle-encapsulated mRNA-based vaccine that encodes the prefusion stabilized full-length spike protein of the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), the virus that causes Covid-19. Methods This phase 3 randomized, observer-blinded, placebo-controlled trial was conducted at 99 centers across the United States. Persons at high risk for SARS-CoV-2 infection or its complications were randomly assigned in a 1:1 ratio to receive two intramuscular injections of mRNA-1273 (100 μg) or placebo 28 days apart. The primary end point was prevention of Covid-19 illness with onset at least 14 days after the second injection in participants who had not previously been infected with SARS-CoV-2. Results The trial enrolled 30,420 volunteers who were randomly assigned in a 1:1 ratio to receive either vaccine or placebo (15,210 participants in each group). More than 96% of participants received both injections, and 2.2% had evidence (serologic, virologic, or both) of SARS-CoV-2 infection at baseline. Symptomatic Covid-19 illness was confirmed in 185 participants in the placebo group (56.5 per 1000 person-years; 95% confidence interval [CI], 48.7 to 65.3) and in 11 participants in the mRNA-1273 group (3.3 per 1000 person-years; 95% CI, 1.7 to 6.0); vaccine efficacy was 94.1% (95% CI, 89.3 to 96.8%; P Conclusions The mRNA-1273 vaccine showed 94.1% efficacy at preventing Covid-19 illness, including severe disease. Aside from transient local and systemic reactions, no safety concerns were identified. (Funded by the Biomedical Advanced Research and Development Authority and the National Institute of Allergy and Infectious Diseases; COVE number, NCT04470427.).

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Topics: Vaccine efficacy (62%), Breakthrough infection (53%), Placebo (50%)

2,721 Citations

Journal ArticleDOI: 10.1016/S0033-8389(01)00017-3
Laura Liberman1, Jennifer H. MenellInstitutions (1)
Abstract: The Breast Imaging Reporting and Data System (BI-RADS) lexicon was developed by the American College of Radiology to standardize mammographic reporting. The BI-RADS lexicon defines terms to describe abnormalities on mammograms, and it defines final assessment categories that are predictive of the likelihood of malignancy. Although the lexicon is clinically useful and facilitates communication and research, there is still substantial interobserver variability in its application. Lexicons for breast sonography and breast MRI are in progress.

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Topics: Breast MRI (61%), Breast imaging (61%), BI-RADS (58%) ... read more

2,089 Citations

Open accessJournal ArticleDOI: 10.1056/NEJMOA1911793
Abstract: Background There are limited data from randomized trials regarding whether volume-based, low-dose computed tomographic (CT) screening can reduce lung-cancer mortality among male former and...

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616 Citations

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