Reactive axillary lymph nodes after COVID-19 mRNA vaccination: comparison of mRNA vs. attenuated whole-virus vaccines

Mehmet Emin Adin; Edvin Isufi; Jennifer Wu; Yulei Pang; Daniel Nguyen; Duygu Simsek Has; Civan Caner; Noha Aboueldaha; Mahmud Mossa-Basha; Darko Pucar

doi:10.1097/MNM.0000000000001833

Reactive axillary lymph nodes after COVID-19 mRNA vaccination: comparison of mRNA vs. attenuated whole-virus vaccines

Nucl Med Commun. 2024 Mar 11. doi: 10.1097/MNM.0000000000001833. Online ahead of print.

Authors

Affiliations

¹ Department of Radiology and Biomedical Imaging, Yale School of Medicine, New Haven, Connecticut, .
² Departments of Radiology, University of Missouri, Columbia, Missouri, .
³ Department of Mathematics, Southern Connecticut State University, New Haven, Connecticut, .
⁴ University of Massachusetts Chan Medical School, Worcester, Massachusetts, USA, .
⁵ Department of Nuclear Medicine, Istanbul School of Medicine, Istanbul University, Istanbul, Turkey .
⁶ Department of Radiology, Washington University School of Medicine, Seattle, Washington and .
⁷ Departments of Radiology, Cleveland Clinic, Weston, Florida, USA.

PMID: 38465449
DOI: 10.1097/MNM.0000000000001833

Abstract

Objective: To compare the incidence and natural course of reactive axillary lymph nodes (RAL) between mRNA and attenuated whole-virus vaccines using Deauville criteria.

Methods: In this multi-institutional PET-CT study comprising multiple vaccine types (Pfizer-BioNTech/Comirnaty, Moderna/Spikevax, Sinovac/CoronaVac and Janssen vaccines), we evaluated the incidence and natural course of RAL in a large cohort of oncological patients utilizing a standardized Deauville scaling system (n=522; 293 Female, Deauville 3-5 positive for RAL). Univariate and multivariate analyses were conducted to evaluate the predictive value of clinical parameters (absolute neutrophil count [ANC], platelets, age, sex, tumor type, and vaccine-to-PET interval) for PET positivity.

Results: Pfizer-BioNTech/Comirnaty and Moderna vaccines revealed similar RAL incidences for the first 20 days after the second dose of vaccine administration (44% for the first 10 days for both groups, 26% vs. 20% for 10-20 days, respectively for Moderna and Pfizer). However, Moderna recipients revealed significantly higher incidences of RAL after 20 days compared to Pfizer-BioNTech/Comirnaty, with nodal reactivity spanning up to the 9th week post-vaccination (15% vs. 4%, respectively P < 0.001). No RAL was observed in patients who received either a single dose of J&J vaccine or two doses of CroronaVac. Younger patients showed increased likelihood of RAL, otherwise, clinical/demographic parameters were not predictive of RAL (P = 0.014 for age, P > 0.05 for additional clinical/demographic parameters).

Conclusion: RAL based on strict PET criteria was observed with mRNA but not with attenuated whole-virus vaccines, in line with higher immunogenicity and stronger protection offered by mRNA vaccines.