Experts suggest new follow-up imaging protocols for vaccine-related lymphadenopathy

Experts are reporting that follow-up ultrasound imaging for reactive axillary lymphadenopathy is likely not necessary before 12 weeks. 

A new study published in Radiology followed 88 women diagnosed with reactive axillary lymphadenopathy after receiving a COVID vaccine for several months to monitor for changes on ultrasound imaging. Persistent lymph node swelling was observed on imaging for more than 50% of women at the 12-week mark, prompting experts to suggest this follow-up time interval as a reasonable guideline. 

“As more studies with long-term data are being published and radiologists continue to gain more clinical experience, it is becoming clear that both the incidence and duration of vaccine-related adenopathy are greater than initially expected,” Dr. Linday Moy, professor of radiology at New York University and senior deputy editor for Radiology, and Dr. Eric Kim, clinical assistant professor in the breast imaging section of the Department of Radiology at the NYU Grossman School of Medicine and a Senior Deputy Editor of the Radiology In Training editorial board, wrote in an editorial alongside the article by Ha et al. “The recommendation by Ha and colleagues to increase the follow-up imaging interval from 4-12 weeks to more than 12 weeks seems reasonable to reduce the number of follow-up examinations.” 

The study consisted of a cohort of 88 asymptomatic women without breast cancer who had been vaccinated against COVID and soon after developed axillary lymphadenopathy. Each woman underwent serial ultrasound imaging to monitor changes over a median period of 12 weeks. Experts assessed cortical thickness, number of lymph nodes, morphology and Doppler signal on all imaging.