Morphological and Metabolic Criteria of COVID-19 Vaccine Associated Axillary Nodes on 18-Fluorodeouxyglucose PET/CT Imaging in Breast Cancer Patients

Nosheen Fatima, Unaiza Zaman, Areeba Zaman, Sidra Zaman, Rabia Tahseen, Maseeh Uz Zaman

Research output: Contribution to journalArticlepeer-review

Abstract

Background: In the current era vaccine-associated lymphadenopathy (VAL) is not an uncommon presentation on 18F-FDG PET/CT examinations in patients inoculated with Coronavirus disease 2019 (COVID-19) vaccination. In this study, we are presenting data of VAL on 18F-FDG PET/CT regarding its prevalence, temporal response to vaccination and imaging characteristics of VAL. Methods: Seventy-eight (78) consecutive vaccinated breast cancer (BC) patients who had 18FDG PET/CT were retrospectively analyzed. All patients had COVID-19 vaccine shots in contralateral arms and none in breast cancer site axilla (BSA). In 35 patients 18FDG avid nodes were found in vaccine site axilla (VSA). In 25 patients 18FDG avid nodes were found in BSA. Morphological criteria on CT images like size, presence of fatty hila and fat stranding of axillary nodes were analyzed. Metabolic criteria on PET images like SUVmax of nodes and liver as reference were also measured. Results: Out of 78 patients, 35 had positive nodes in VSA (45% prevalence) and 25/78 had BSA (33% prevalence). Mean duration of COVID-19 vaccination in each group was 8 ±04 week (non-significant p-value). On CT images, 18FDG avid nodes in VSA were significantly smaller (10 ± 03 mm) and with intact fatty hila without fat stranding than nodes in BSA with loss of fatty hila (25 ±10 mm; p <0.0001). Mean SUVmax of nodes in VSA was significantly lower (2.4 ±1.1) than nodes in BSA (10.2 ±5.5 - p-value <0.0001). Nodes in VSA showed a significant positive linear correlation between size and SUVmax (p-value 0.00001). Similarly, nodes in VSA showed a significant negative linear correlation between duration and SUVmax (p-value 0.00003). In VSA group, 03 patients having SUVmax >2 SD of Hepatic SUVmax were subjected to ultrasound guided fine needle aspiration (FNA) and turned out to be metastatic in nature. Conclusion: In COVID-19 vaccinated patients with BC, 18FDG avid nodes in VSA may pose diagnostic challenge. However, morphological (size < 10 mm short axis, intact fatty hila without fat stranding) and metabolic criteria (SUVmax <2.4 with negative correlation with time of inoculation) have higher diagnostic accuracy in resolving the dilemma. Nodes in VSA having SUVmax > 2 SD of hepatic SUVmax should be considered for FNA to rule out possible metastasis.

Original languageEnglish
Pages (from-to)4053-4057
Number of pages5
JournalAsian Pacific Journal of Cancer Prevention
Volume24
Issue number12
DOIs
Publication statusPublished - 2023

Keywords

  • COVID-19 vaccine
  • FDG PET/CT
  • breast cancer
  • vaccine associated lymphadenopathy
  • vaccine site axilla

Fingerprint

Dive into the research topics of 'Morphological and Metabolic Criteria of COVID-19 Vaccine Associated Axillary Nodes on 18-Fluorodeouxyglucose PET/CT Imaging in Breast Cancer Patients'. Together they form a unique fingerprint.

Cite this