Lymphadenopathy Associated with COVID-19 Vaccination Mimicking Breast Cancer Related Axillary LAP: Imaging Findings in Review of 880 Cases COVID-19 Vaccination LAP mimicking breast cancer

Pedram Keshavarz (1), Fereshteh Yazdanpanah (2), Seyed Faraz Nejati (3), Faranak Ebrahimian Sadabad (4), Fatemeh Bagheri (5), Malkhaz Mizandari (6)
(1) Department of Radiological Sciences, David Geffen School of Medicine, University of California, Los Angeles (UCLA), Los Angeles, USA, United States,
(2) Network of Immunity in Infection, Malignancy and Autoimmunity (NIIMA), Universal Scientific Education and Research Network (USERN), Tabriz, Iran, Iran, Islamic Republic of,
(3) Faraparto Medical Imaging & Interventional Radiology Research Center, Shiraz, Iran, Iran, Islamic Republic of,
(4) Faraparto Medical Imaging & Interventional Radiology Research Center, Shiraz, Iran, Iran, Islamic Republic of,
(5) Faraparto Medical Imaging & Interventional Radiology Research Center, Shiraz, Iran, Iran, Islamic Republic of,
(6) Department of Radiology of Tbilisi State Medical University (TSMU), Tbilisi, Georgia, USA, Georgia


Background: With an increasing rate of lymphadenopathies (LAP) reported following COVID-19 vaccination with various vaccines’ types, which can mimic breast cancer (BC), a comprehensive review, can disclose some practical information about BC workup that reduces the incidence and mortality of the disease along with unnecessary steps.

Methods: We conducted a literature search in online databases, including Scopus, Medline (PubMed), Web of Science, Embase (Elsevier), Cochrane library, and Google Scholar. Keywords of literature search included “COVID-19”, “coronavirus disease”, “Vaccine”, and “Vaccination”, “LAP”, “Adverse event*”, “Lymph node”, “Cancer, breast”, and “Lymphadenopathy”.

Results: In total, 59 studies (n = 880 cases), including 412 (46.8%) females, 146 (16.6%) males, and 322 (36.6%) cases with unknown gender were reviewed. We reviewed the LAP presentation after vaccination of first or second dosage of Pfizer-BioNTech (n = 754, 85.7%), Moderna (n = 38, 4.3%), Oxford-AstraZeneca (n = 39, 4.4%), Sputnik V (n = 1, 0.1%), Johnson & Johnson/Janssen (n = 1, 0.1%), CureVac (n = 1, 0.1%), and in 46 (5.3%) cases, the type of vaccine was not reported. The most common LAP locations were axillary (n = 540) and followed by axillary and supraclavicular (n = 271). We found that imaging findings of LAP associated with vaccination were seen from the first day to two months after vaccination of the first or second dosage of different types of COVID-19 vaccines.

Conclusion:  This review study can draw a broad perspective by focusing on patients with cancer, especially BC, for clinicians to proceed with the right approach at the right time without additional invasive measures and not to hold the necessary action in high-risk patients at the same time.

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Hsiang S, Allen D, Annan-Phan S, Bell K, Bolliger I, Chong T, et al. The effect of large-scale anti-contagion policies on the COVID-19 pandemic. Nature. 2020;584(7820):262-7. doi: 10.1038/s41586-020-2404-8.

Website WHO. WHO coronavirus (COVID-19) dashboard . Available from:

Yazdanpanah F, Hamblin MR, Rezaei N. The immune system and COVID-19: Friend or foe? Life sciences. 2020;256:117900. doi: 10.1016/j.lfs.2020.117900.

Keshavarz P, Rafiee F, Kavandi H, Goudarzi S, Heidari F, Gholamrezanezhad A. Ischemic gastrointestinal complications of COVID-19: a systematic review on imaging presentation. Clinical imaging. 2020. doi: 10.1016/j.clinimag.2020.11.054.

Akbari H, Tabrizi R, Lankarani KB, Aria H, Vakili S, Asadian F, et al. The role of cytokine profile and lymphocyte subsets in the severity of coronavirus disease 2019 (COVID-19): a systematic review and meta-analysis. Life sciences. 2020:118167. doi: 10.1016/j.lfs.2020.118167.

Prevention CfDCa. Different COVID-19 vaccines 2021. Available from:

Website WHO. WHO coronavirus (COVID-19) dashboard 2021. Available from:

MJ EO, Juanes de Toledo B. Pfizer-BioNTech, la primera vacuna ARNm contra la COVID-19, parece segura y eficaz.

Local reactions ae, and serious adverse events: Pfizer-BioNTech COVID-19 vaccine. Centers for Disease Control and Prevention, Centers for Disease Control and Prevention; December 20, 2020 2021. Available from:

Local reactions ae, and serious adverse events: Moderna COVID-19 vaccine. Centers for Disease Control and Prevention, Centers for Disease Control and Prevention. December 13, 2020 2021. Available from:

Lehman CD, Lamb LR, D'Alessandro HA. Mitigating the impact of coronavirus disease (COVID-19) vaccinations on patients undergoing breast imaging examinations: a pragmatic approach. American Journal of Roentgenology. 2021. doi: 10.2214/AJR.21.25688.

Gaddey HL, Riegel AM. Unexplained lymphadenopathy: evaluation and differential diagnosis. American family physician. 2016;94(11):896-903.

Keshavarz P, Yazdanpanah F, Rafiee F, Mizandari M. Lymphadenopathy Following COVID-19 Vaccination: Imaging Findings Review. Academic Radiology. 2021. doi: 10.1016/j.acra.2021.04.007.

Cocco G, Delli Pizzi A, Fabiani S, Cocco N, Boccatonda A, Frisone A, et al. Lymphadenopathy after the Anti-COVID-19 Vaccine: Multiparametric Ultrasound Findings. Biology. 2021;10(7):652. doi: 10.3390/biology10070652.

Schapiro R, Moncayo VM, Meisel JL. Case report of lymph node activation mimicking cancer progression: A false positive F18 FDG PET CT after COVID-19 vaccination. Current Problems in Cancer: Case Reports. 2021;4:100092. doi: 10.1016/j.cpccr.2021.100092.

Cardoso F, Reis A, Osório C, Scigliano H, Nora M. A Case of Cervical Lymphadenopathy After Vaccination Against COVID-19. Cureus. 2021;13(5). doi:10.7759/cureus.15050.

Fleury V, Maucherat B, Rusu D, Dumont F, Rousseau C. COVID-19 vaccination may cause FDG uptake beyond axillary area. European Journal of Hybrid Imaging. 2021;5(1):1-3. doi: 10.1186/s41824-021-00105-2.

Granata V, Fusco R, Setola SV, Galdiero R, Picone C, Izzo F, et al. Lymphadenopathy after bnt162b2 covid-19 vaccine: Preliminary ultrasound findings. Biology. 2021;10(3):214. doi: 10.3390/biology10030214.

Shin M, Hyun CY, Choi YH, Choi JY, Lee K-H, Cho YS. COVID-19 Vaccination-Associated Lymphadenopathy on FDG PET/CT: Distinctive Features in Adenovirus-Vectored Vaccine. Clinical Nuclear Medicine. 2021. doi: 10.1097/RLU.0000000000003800.

Mehta N, Sales RM, Babagbemi K, Levy AD, McGrath AL, Drotman M, et al. Unilateral axillary Adenopathy in the setting of COVID-19 vaccine. Clinical imaging. 2021;75:12-5. doi: 10.1016/j.clinimag.2021.01.016.

Eshet Y, Tau N, Alhoubani Y, Kanana N, Domachevsky L, Eifer M. Prevalence of Increased FDG PET/CT Axillary Lymph Node Uptake Beyond 6 Weeks after mRNA COVID-19 Vaccination. Radiology. 2021:210886. doi: 10.1148/radiol.2021210886.

Placke J-M, Reis H, Hadaschik E, Roesch A, Schadendorf D, Stoffels I, et al. Coronavirus disease 2019 vaccine mimics lymph node metastases in patients undergoing skin cancer follow-up: A monocentre study. European journal of cancer. 2021;154:167-74. doi: 10.1016/j.ejca.2021.06.023.

Weeks JK, O’Brien SR, Rosenspire KC, Dubroff JG, Pantel AR. Evolving Bilateral Hypermetabolic Axillary Lymphadenopathy on FDG PET/CT Following 2-Dose COVID-19 Vaccination. Clinical Nuclear Medicine. 2021. doi: 10.1097/RLU.0000000000003711.

Bass D, Puri S. FDG-Avid Ipsilateral Iliac and Inguinal Lymphadenopathy After COVID-19 Vaccination With Thigh Injection. American Journal of Roentgenology. 2021. doi: 10.2214/AJR.21.26491.

Robinson KA, Maimone S, Gococo-Benore DA, Li Z, Advani PP, Chumsri S. Incidence of Axillary Adenopathy in Breast Imaging After COVID-19 Vaccination. JAMA Oncology. 2021;7(9):1395-7. doi: 10.1001/jamaoncol.2021.3127.

Mango VL, Pilewskie M, Jochelson MS. To Look or Not to Look? Axillary Imaging: Less May Be More. Journal of Breast Imaging. 2021;3(6):666-71. doi: 10.3390/jcm10071543.

Saksena M, Jimenez R, Coopey S, Harris K. Axillary ultrasound evaluation in breast cancer patients: a multidisciplinary viewpoint and middle ground. Journal of Breast Imaging. 2021;3(6):672-5. doi: 10.4048/jbc.2022.25.e10.

Whitman GJ, Lu TJ, Adejolu M, Krishnamurthy S, Sheppard D. Lymph Node Sonography. Ultrasound Clinics. 2011;6(3):369-80. doi: 10.1016/j.cult.2011.05.005.

Neal CH, Daly CP, Nees AV, Helvie MA. Can preoperative axillary US help exclude N2 and N3 metastatic breast cancer? Radiology. 2010;257(2):335-41. doi: 10.1148/radiol.10100296.

Dialani V, Dogan B, Dodelzon K, Dontchos BN, Modi N, Grimm L. Axillary Imaging Following a New Invasive Breast Cancer Diagnosis—A Radiologist’s Dilemma. Journal of Breast Imaging. 2021;3(6):645-58. doi: 10.1093/jbi/wbab082.

Rauch GM, Kuerer HM, Jochelson MS. To look or not to look? Yes to nodal ultrasound! Journal of Breast Imaging. 2021;3(6):659-65. doi: 10.2214/AJR.16.17223.

Schiaffino S, Pinker K, Magni V, Cozzi A, Athanasiou A, Baltzer PA, et al. Axillary lymphadenopathy at the time of COVID-19 vaccination: ten recommendations from the European Society of Breast Imaging (EUSOBI). Insights into Imaging. 2021;12(1):1-7. doi: 10.1186/s13244-021-01062-x.

Tu W, Gierada DS, Joe BN. COVID-19 vaccination-related lymphadenopathy: what to be aware of. Radiological Society of North America; 2021. doi: 10.1148/rycan.2021210038.

Garreffa E, Hamad A, O'Sullivan CC, Hazim AZ, York J, Puri S, et al. Regional lymphadenopathy following COVID-19 vaccination: Literature review and considerations for patient management in breast cancer care. Eur J Cancer. 2021;159:38-51. doi: 10.1016/j.ejca.2021.09.033.

Lim J, Lee SA, Khil EK, Byeon SJ, Kang HJ, Choi JA. COVID-19 vaccine-related axillary lymphadenopathy in breast cancer patients: Case series with a review of literature. Semin Oncol. 2021;48(4-6):283-91. doi: 10.1053/j.seminoncol.2021.10.002

Washington T, Bryan R, Clemow C. Adenopathy following COVID-19 vaccination. Radiology. 2021;299(3):E280-E1. doi: 10.1148/radiol.2021210236.

Lehman CD, D’Alessandro HA, Mendoza DP, Succi MD, Kambadakone A, Lamb LR. Unilateral lymphadenopathy after COVID-19 vaccination: a practical management plan for radiologists across specialties. Journal of the American College of Radiology. 2021;18(6):843-52. doi: 10.1016/j.jacr.2021.03.001

Mortazavi S. Coronavirus disease (COVID-19) vaccination associated axillary adenopathy: imaging findings and follow-up recommendations in 23 women. American Journal of Roentgenology. 2021. doi: 10.2214/AJR.21.25651.

Duke H, Posch L, Green L. Axillary adenopathy following COVID-19 vaccination: A single institution case series. Clinical Imaging. 2021. doi:10.1016/j.clinimag.2021.05.023.

Faermann R, Nissan N, Neiman OH, Shalmon A, Gotlieb M, Yagil Y, et al. COVID-19 vaccination induced lymphadenopathy in a specialized breast imaging clinic in Israel: Analysis of 163 cases. Academic Radiology. 2021. doi: 10.1016/j.acra.2021.06.003.

Mitchell O, Couzins M, Dave R, Bekker J, Brennan P. COVID-19 vaccination and low cervical lymphadenopathy in the two week neck lump clinic-a follow up audit. British Journal of Oral and Maxillofacial Surgery. 2021. doi: 10.1016/j.bjoms.2021.04.008.

Ahn RW, Mootz AR, Brewington CC, Abbara S. Axillary lymphadenopathy after mRNA COVID-19 vaccination. Radiology: Cardiothoracic Imaging. 2021;3(1):e210008. doi: 10.1148/ryct.2021210008.

Hiller N, Goldberg SN, Cohen-Cymberknoh M, Vainstein V, Simanovsky N. Lymphadenopathy associated with the COVID-19 vaccine. Cureus. 2021;13(2). doi: 10.7759/cureus.13524.

Özütemiz C, Krystosek LA, Church AL, Chauhan A, Ellermann JM, Domingo-Musibay E, et al. Lymphadenopathy in COVID-19 vaccine recipients: diagnostic dilemma in oncology patients. Radiology. 2021:210275. doi: 10.1148/radiol.2021210275.

Brown A, Shah S, Dluzewski S, Musaddaq B, Wagner T, Szyszko T, et al. Unilateral axillary adenopathy following COVID-19 vaccination: a multimodality pictorial illustration and review of current guidelines. Clinical Radiology. 2021. doi: 10.1016/j.crad.2021.04.010.

Dominguez JL, Eberhardt SC, Revels JW. Unilateral axillary lymphadenopathy following COVID-19 vaccination: A case report and imaging findings. Radiology Case Reports. 2021;16(7):1660-4. doi: 10.1016/j.radcr.2021.04.015.

Abou-Foul AK, Ross E, Abou-Foul M, George AP. Cervical lymphadenopathy following COVID-19 vaccine: Clinical characteristics and implications for head and neck cancer services. Authorea Preprints. 2021. doi: 10.1017/S0022215121002462.

Becker AS, Perez-Johnston R, Chikarmane SA, Chen MM, El Homsi M, Feigin KN, et al. Multidisciplinary recommendations regarding post-vaccine adenopathy and radiologic imaging: radiology scientific expert panel. Radiology. 2021:210436. doi: 10.1148/radiol.2021210436.

Cellina M, Irmici G, Carrafiello G. Unilateral Axillary Lymphadenopathy After Coronavirus Disease (COVID-19) Vaccination. American Journal of Roentgenology. 2021;216(5):W27. doi: 10.2214/AJR.21.25683.

Garreffa E, York J, Turnbull A, Kendrick D. Regional lymphadenopathy following COVID-19 vaccination: considerations for primary care management. British Journal of General Practice. 2021;71(707):284-5. doi: 10.3399/bjgp21X716117.

D’Auria D, Fulgione L, Romeo V, Stanzione A, Maurea S, Brunetti A. Ultrasound and shear-wave elastography patterns of COVID-19 mRNA vaccine-related axillary, supra and subclavicular lymphadenopathy. Clinical and Translational Imaging. 2021:1-7. doi: 10.1007/s40336-021-00441-0.

Edmonds CE, Zuckerman SP, Conant EF. Management of unilateral axillary lymphadenopathy detected on breast MRI in the era of coronavirus disease (COVID-19) vaccination. American Journal of Roentgenology. 2021. doi: 10.2214/AJR.21.25604.

Bauckneht M, Aloè T, Tagliabue E, Cittadini G, Guadagno A, Morbelli S, et al. Beyond Covid-19 vaccination-associated pitfalls on [18F] Fluorodeoxyglucose (FDG) PET: a case of a concomitant sarcoidosis. Eur J Nucl Med Mol Imaging. 2021. doi: 10.1007/s00259-021-05360-w.

Canan A, Kukkar V. Unilateral lymphadenopathy after COVID-19 vaccination. Lung India. 2021;38(3):294-. doi: 10.4103/lungindia.lungindia_91_21.

Nawwar AA, Searle J, Singh R, Lyburn ID. Oxford-AstraZeneca COVID-19 vaccination induced lymphadenopathy on [18F] choline PET/CT—not only an FDG finding. European Journal of Nuclear Medicine and Molecular Imaging. 2021:1-2. doi: 10.1007/s00259-021-05279-2.

Cohen D, Krauthammer SH, Wolf I, Even-Sapir E. Hypermetabolic lymphadenopathy following administration of BNT162b2 mRNA Covid-19 vaccine: incidence assessed by [18 F] FDG PET-CT and relevance to study interpretation. European Journal of Nuclear Medicine and Molecular Imaging. 2021;48(6):1854-63. doi: 10.1007/s00259-021-05314-2.

Ulaner GA, Giuliano P. 18F-FDG-Avid Lymph Nodes After COVID-19 Vaccination on 18F-FDG PET/CT. Clinical nuclear medicine. 2021. doi: 10.1097/RLU.0000000000003633.

Brown AH, Shah S, Groves AM, Wan S, Malhotra A. The Challenge of Staging Breast Cancer With PET/CT in the Era of COVID Vaccination. Clinical Nuclear Medicine. 2021. doi: 10.1097/RLU.0000000000003683.

Steinberg J, Thomas A, Iravani A. 18F-fluorodeoxyglucose PET/CT findings in a systemic inflammatory response syndrome after COVID-19 vaccine. The Lancet. 2021;397(10279):e9. doi: 10.1016/S0140-6736(21)00464-5.

Smith MV, Yang M. Reactive axillary lymphadenopathy to COVID-19 vaccination on F18-FDG PET/CT. Journal of Nuclear Medicine Technology. 2021. doi: 10.2967/jnmt.121.262008.

Singh B, Kaur P, Kumar V, Maroules M. COVID-19 vaccine induced Axillary and Pectoral Lymphadenopathy on PET scan. Radiology Case Reports. 2021;16(7):1819-21. doi: 10.1016/j.radcr.2021.04.053.

Shah S, Wagner T, Nathan M, Szyszko T. COVID-19 vaccine-related lymph node activation–patterns of uptake on PET-CT. BJR| case reports. 2021;7(3):20210040. doi: 10.1259/bjrcr.20210040.

Schroeder DG, Jang S, Johnson DR, Takahashi H, Navin PJ, Broski SM, et al. Frequency and Characteristics of Nodal and Deltoid FDG and 11C-Choline Uptake on PET Imaging Performed After COVID-19 Vaccination. American Journal of Roentgenology. 2021. doi: 10.2214/AJR.21.25928.

Finnegan J, Govender P, Torreggiani WC. Re: Unilateral axillary adenopathy in the setting of COVID-19 vaccine, Clinical Imaging, January 2021. Clinical Imaging. 2021;75:171-2. doi: 10.1016/j.clinimag.2021.02.045.

Doss M, Nakhoda SK, Li Y, Yu JQ. COVID-19 Vaccine-Related Local FDG Uptake. Clinical Nuclear Medicine. 2021. doi: 10.1097/RLU.0000000000003634.

Bernstine H, Priss M, Anati T, Turko O, Gorenberg M, Steinmetz AP, et al. Axillary lymph nodes hypermetabolism after BNT162b2 mRNA COVID-19 vaccination in cancer patients undergoing 18F-FDG PET/CT: a cohort study. Clinical Nuclear Medicine. 2021;46(5):396-401. doi: 10.1097/RLU.0000000000003648.

Ahmed N, Muzaffar S, Binns C, Ilyas MW, Usmani S. COVID-19 vaccination manifesting as incidental lymph nodal uptake on 18F-FDG PET/CT. Clin Nucl Med. 2021;10. doi: 10.1097/RLU.0000000000003635.

Eifer M, Eshet Y. Imaging of COVID-19 Vaccination at FDG PET/CT. Radiology. 2021;299(2):E248-E. doi: 10.1148/radiol.2020210030.

Johnson BJ, Van Abel K, Ma D, Johnson DR. FDG avid axillary lymph nodes after COVID-19 vaccination. Journal of Nuclear Medicine. 2021. doi: 10.1007/s40336-021-00430-3.

Moghimi S, Wilson D, Martineau P. FDG PET findings post-COVID vaccinations: signs of the times? Clinical Nuclear Medicine. 2021. doi: 10.1097/RLU.0000000000003636.

Avner M, Orevi M, Caplan N, Popovtzer A, Lotem M, Cohen JE. COVID-19 vaccine as a cause for unilateral lymphadenopathy detected by 18F-FDG PET/CT in a patient affected by melanoma. European Journal of Nuclear Medicine and Molecular Imaging. 2021:1-2. doi: 10.1007/s00259-021-05278-3.

McIntosh LJ, Bankier AA, Vijayaraghavan GR, Licho R, Rosen MP. COVID-19 vaccination-related uptake on FDG PET/CT: an emerging dilemma and suggestions for management. American Journal of Roentgenology. 2021. doi: 10.2214/AJR.21.25728.

Xu G, Lu Y. COVID-19 mRNA Vaccination-Induced Lymphadenopathy Mimics Lymphoma Progression on FDG PET/CT. Clinical nuclear medicine. 2021. doi: 10.1097/RLU.0000000000003597.

McIntosh LJ, Rosen MP, Mittal K, Whalen GF, Bathini VG, Ali T, et al. Coordination and optimization of FDG PET/CT and COVID-19 vaccination; Lessons learned in the early stages of mass vaccination. Cancer Treatment Reviews. 2021;98. doi: 10.1016/j.ctrv.2021.102220.

Adin ME, Isufi E, Kulon M, Pucar D. Association of COVID-19 mRNA Vaccine With Ipsilateral Axillary Lymph Node Reactivity on Imaging. JAMA oncology. 2021. doi:10.1001/jamaoncol.2021.1794.

Hanneman K, Iwanochko RM, Thavendiranathan P. Evolution of lymphadenopathy at PET/MRI after COVID-19 vaccination. Radiology. 2021;299(3):E282-E. doi: 10.1148/radiol.2021210386.

Lu Y. DOTATATE-Avid Bilateral Axilla and Subpectoral Lymphadenopathy Induced From COVID-19 mRNA Vaccination Visualized on PET/CT. Clinical nuclear medicine. 2021. doi: 10.1097/RLU.0000000000003697.

Weiler-Sagie M, Half EE. [68 Ga] Ga-DOTA-TATE uptake due to COVID-19 vaccination. European Journal of Nuclear Medicine and Molecular Imaging. 2021:1-2. doi: 10.1007/s00259-021-05414-z.

Brophy J, Henkle G, Rohren EM. DOTATATE Uptake in an Axillary Lymph Node After COVID-19 Vaccination. Clinical nuclear medicine. 2021. doi: 10.1097/RLU.0000000000003847.


Pedram Keshavarz
Fereshteh Yazdanpanah
Seyed Faraz Nejati
Faranak Ebrahimian Sadabad
Fatemeh Bagheri
Malkhaz Mizandari (Primary Contact)
Keshavarz P, Yazdanpanah F, Nejati SF, Ebrahimian Sadabad F, Bagheri F, Mizandari M. Lymphadenopathy Associated with COVID-19 Vaccination Mimicking Breast Cancer Related Axillary LAP: Imaging Findings in Review of 880 Cases: COVID-19 Vaccination LAP mimicking breast cancer. Arch Breast Cancer [Internet]. 2022 Apr. 23 [cited 2024 Jul. 14];9(3). Available from:

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