Cervical lymphadenopathy following COVID-19 vaccine: Clinical
characteristics and implications for head and neck cancer services
Abstract
Objectives: Lower neck lymphadenopathy usually harbour
malignancy in around 75% of cases, and should warrant an urgent
referral to the head and neck (H&N) cancer services. The presented work
is the first study to report on the incidence, clinical course, and
imaging features of cervical CVAL (cCVAL), with special emphasis on the
implications for the H&N cancer services.
Design: Retrospective cohort study.
Setting: Leading UK NHS trust providing tertiary H&N cancer
services.
Participants: Patients referred to our H&N cancer clinics with
cCVAL between 16 December 2020 and 12 March 2021 (12 weeks). We defined
cCVAL as any unilateral and lower cervical lymphadenopathy, noticed
within two weeks of COVID-19 vaccination in the ipsilateral deltoid
muscle.
Main outcome measures: The proportion of patients referred with
cCVAL. Secondary outcomes included the clinical and imaging
characteristics and follow-up measures.
Results: From 88 patients referred with cervical
lymphadenopathy, 13 patients (14.8%) had cCVAL. Pain was only reported
in six patients (46.2%), but swelling was noticed by all patients
within a median of four days. The average diameter of CVALs on
ultrasound scans was 5.5 ± 1.4 mm, and five patients (38.5%) had
abnormally looking rounded node or increased vascularity on colour
doppler. Seven patients (53.9%) reported full resolution of their
lymphadenopathy within an average of 3.1 ± 2.3 weeks.
Conclusion: Reactive cervical CVAL can mimic malignant
lymphadenopathy, and therefore might prove challenging to correctly
diagnose and manage. Over the next few months, primary care and H&N
cancer services should be prepared for a potentially significant
increase in referrals.
Keywords: COVID-19 vaccine, lymphadenopathy, Head and Neck
Neoplasms, neck ultrasonography, Head and neck malignancy
Key points
-Reactive cervical COVID-19 vaccine-associated lymphadenopathy (CVAL)
can mimic malignant lymphadenopathy with abnormal features on imaging.
-Cervical CVAL might create a diagnostic and management dilemma for the
head and neck cancer services.
-Cervical CVAL might fully resolve within a period of 3-6 weeks in more
than half of the patients, and therefore referrals should be
rationalised.
- Over the next few months, primary care and H&N cancer services will
potentially encounter a rise in vaccine-related reactive lymphadenopathy
referrals.
- COVID-19 vaccination history must be included in all referrals with
head and neck lymphadenopathy.
Manuscript: (Word count: 2500)