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.
摘要:
目的:通过临床影像学研究恶性高代谢腋窝淋巴结病(MHL)与COVID-19疫苗相关腋窝高代谢淋巴结病(VAHL)的差异。方法:2021年6月1日至2022年4月30日,共有1096例患者在爱媛大学医院接受了正电子发射断层扫描-计算机断层扫描(PET-CT)。总的来说,对188例COVID-19疫苗接种后的腋窝淋巴结病患者进行了评估。将患者分为三组,如VAHL(n=27),MHL(n=21),和模棱两可的高代谢腋窝淋巴结病(EqHL;n=140)。淋巴结(LN)肿胀的差异使用临床成像(回波描记术,CT,和18F-FDGPET)。结果:由于乳腺癌的发生率较高(80.9%),MHL包括较高的女性人群(90.5%)。MHL的腋窝LN没有显示任何LN脂肪门(0%);然而,VAHL和EqHL做到了(15.8%和36%,分别)。对无LN脂肪肺门的腋窝淋巴结病患者进行logistic回归分析,最大腋窝LN的短轴长度和椭圆率(短轴/长轴),SUVmax,和组织背景比(TBR)可用于区分恶性淋巴结病。接收器工作特性(ROC)分析表明,腋窝LN短轴的临界值≥7.3mm(灵敏度:0.714,特异性:0.684)和椭圆率的临界值≥0.671(分别为0.667和0.773)在最大的LN中具有最高的SUVmax和TBR可以预测MHL。结论:无脂肪肺门的LN中短轴的腋窝淋巴结肿大和椭圆可能有助于怀疑恶性肿瘤。即使是接受过COVID-19疫苗接种的患者。进一步检查,如18F-FDGPET,建议这样的病人。