limitations and strengths of the study
Our results are limited by the inherent weakness in retrospectively
collected data. We adapted a strict definition for cCVAL and excluded
cases with upper or bilateral neck nodes, and cases with nodes first
noticed >14 days following vaccination. We believe this
definition increased our specificity and confidence in our diagnosis but
possibly have reduced the sensitivity and missed some cases presented in
atypical ways. In our cohort, lymphadenopathy was spatially and
temporally associated with COVID-19 vaccinations, however, it was
difficult to ascertain a causality link. Our results could be useful and
universally generalisable to members of cancer MDTs, including surgeons,
radiologists, oncologists, and haematologists, in addition to primary
care physicians, vaccinators, and the general public.
Conclusion
The widespread rollout of COVID-19 vaccination has important
implications for clinicians and patients. Over the next few months,
primary care and H&N cancer services will potentially encounter a rise
in vaccine-related reactive lymphadenopathy referrals. Therefore,
COVID-19 vaccination history must be included in all referrals. Reactive
cervical CVAL can mimic malignant lymphadenopathy, and therefore might
become challenging to correctly diagnose and manage. Furthermore,
consideration should be given for alternative strategies and referral
pathways for low-risk patients presenting with lymphadenopathy which
have the COVID-19 vaccination as the most likely aetiology.
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