Management of Unilateral Axillary Lymphadenopathy Detected on Breast MRI in the Era of COVID-19 Vaccination
Management of Unilateral Axillary Lymphadenopathy Detected on Breast MRI in the Era of COVID-19 Vaccination
复制标题
新冠疫苗接种时代乳腺MRI检测出的单侧腋窝淋巴结肿大的处理
DOI：
10.2214/ajr.21.25604
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发表时间：
2021-10-01
影响因子：
5
通讯作者：
Conant, Emily F.
中科院分区：
文献类型：
--
作者：
Edmonds, Christine E.;Zuckerman, Samantha P.;Conant, Emily F.
COVID-19 疫苗接种的早期临床经验表明，与其他疫苗相比，已批准的 COVID-19 疫苗导致乳腺 MRI 上腋窝淋巴结肿大的发生率明显更高。在 COVID-19 疫苗接种时代，需要适当管理 MRI 检测到的单侧腋窝淋巴结肿大的指南，并避免对良性反应性淋巴结进行活检。本文检查了疫苗相关淋巴结肿大的现有数据，并提供了通过 MRI 评估腋窝淋巴结肿大和指导治疗的基本策略。在我们的机构，我们在所有乳腺影像检查之前向患者提供的入院表格中添加了有关 COVID-19 疫苗接种日期和偏侧性的问题。我们认为，如果在接种任一剂量后 4 周内出现 MRI 检测到的与疫苗接种臂同侧的孤立性单侧腋窝淋巴结肿大，则很可能与 COVID-19 疫苗相关。在这些情况下，我们将淋巴结肿大评估为 BI-RADS 3，并建议在给予第二剂后 6-8 周内进行超声随访。随着我们获得有关 COVID-19 疫苗接种后腋窝淋巴结肿大的预期时间进程的进一步数据，这些指南可能会得到完善。在那之前，这种管理途径将有助于避免对良性疫苗相关反应性淋巴结病进行不必要的活检。
Early clinical experience with COVID-19 vaccination suggests that approved COVID-19 vaccines cause a notably higher incidence of axillary lymphadenopathy on breast MRI compared with other vaccines. Guidelines are needed to appropriately manage unilateral axillary lymphadenopathy detected by MRI in the era of COVID-19 vaccination and to avoid biopsies of benign reactive nodes. This article examines the available data on vaccine-related lymphadenopathy and offers a basic strategy for assessing axillary lymphadenopathy on MRI and guiding management. At our institution, we are adding questions regarding the date(s) and laterality of administration of COVID-19 vaccination to the intake form given to patients before all breast imaging examinations. We consider MRI-detected isolated unilateral axillary lymphadenopathy ipsilateral to the vaccination arm to most likely be related to the COVID-19 vaccine if it develops within 4 weeks of administration of either dose. In these cases, we assess the lymphadenopathy as BI-RADS 3 and recommend that follow-up ultrasound be performed within 6-8 weeks after administration of the second dose. These guidelines may be refined as we acquire further data on the expected time course of axillary lymphadenopathy after COVID-19 vaccination. Until that time, this management pathway will help avoid unnecessary biopsies of benign vaccine-related reactive lymphadenopathy.