Introduction
The COVID-19 pandemic caused by the SARS-CoV-2 virus has resulted in
millions of deaths and strained health-care systems all around the
globe. Huge collaborative efforts led to the development and deployment
of successful vaccinations that have shown to reduce the risk of severe
infections and mortality.1-3 In the United Kingdom
(UK), following a rigorous review of safety and efficacy data, the
Pfizer/BioNTech was the first COVID-19 vaccine to be approved by the
Medicines and Healthcare products Regulatory Agency (MHRA), followed by
the Oxford/AstraZeneca and the
Moderna vaccines.1-3 The rollout of COVID-19
vaccination in the UK, and in many other countries, prioritized those
most likely to die from the disease especially older care-homes
residents and immunocompromised adults, as well as protected health and
social care workers.
Similar to other vaccines, local adverse drug reactions (ADRs) like
shoulder pain and erythema, in addition to mild systemic symptoms like
fatigue, myalgia and headache are commonly reported after COVID-19
vaccination.3-6 However, data from recent clinical
trials and early post-marketing clinical experience have suggested a
higher incidence of local lymphadenopathy reactions in the axilla and
neck.3,5-7 With the widespread rollout of COVID-19
vaccination programmes, lymphadenopathy have created a diagnostic and
therapeutic dilemma for cancer screening and diagnosis
services.8-10 For this reason, the United States
Society of Breast Imaging, the Canadian Society of Breast Imaging, the
Canadian Association of Radiologists, and a multidisciplinary team (MDT)
of experts from three leading cancer centres in the United States have
all recently released emergency recommendations for the management of
COVID-19 vaccine-associated lymphadenopathy
(CVAL).7,10,11
Cases of ipsilateral lymphadenopathy in the lower neck and
supraclavicular region following COVID-19 vaccinations are quickly
emerging in the international literature, and certainly being
increasingly referred to the healthcare services for advice and
management.12-14 As lower neck lymphadenopathy usually
harbours malignancy in around 75% of cases, the UK National Institute
for Health and Care Excellence (NICE) recommended fast-track referral of
unexplained or persistent cases through a dedicated pathway for
suspected H&N cancer.15,16 The differential diagnosis
of lymphadenopathy in the lower neck is broad, but it is imperative to
exclude pathologies like head and neck (H&N) malignancy, lymphoma, and
metastatic lung or cutaneous cancers.10,15 However, as
vaccine deployment is still in its early stages, no data is yet
available regarding the presentation, clinical course, or imaging
characteristics of cervical COVID-19 vaccine-associated lymphadenopathy
(CVAL) to guide the decision-making process in such patients. The
presented work is the first study to report on the characteristics and
clinical course of cervical lymphadenopathy following COVID-19
vaccination, with special emphasis on potential implications for the
head and neck cancer services.
Methods