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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。
