Easy Scheme Outlining the Various Morphological and Vascular Abnormalities of the Lymph Node Structure Associated with Recent COVID-19 Vaccination, Each with a Different Clinical/Diagnostic Management
Abstract
:1. Introduction
- Short-term follow-up with US imaging, starting from the fourth week after the second dose and up to the twelfth week.
2. Ultrasound Method in Assessing Lymph Node Morphological Features
- ✓
- Morphology (oval vs. round shape/loss of bipolar ratio in diameter).
- ✓
- Thickening of the cortex (>3 mm).
- ✓
- Color Doppler evaluation (centrally placed vascular hilum vs. small vessels entering cortex of node or no/aberrant vascular hilum).
- ✓
- Adipose hilum (centrally vs. eccentric displacement fatty hilum or hilum absence).
- ✓
- UN 2: Uniform cortex < 3 mm, centrally placed fatty and vascular hilum (color flow ultrasound), oval shape (preserved the long and short axis) (Figure 2).
- ✓
- UN 3: 3 mm cortex with uniform cortical thickness, centrally placed fatty and vascular hilum (color flow ultrasound), oval shape (preserved the bipolar ratio of diameters) (Figure 3).
- ✓
- UN 4: Localized bulge or uniform cortical thickness of cortex > 3 mm, eccentric displacement of fatty hilum, small vessels entering cortex of node (color flow ultrasound), rounded shape (loss of bipolar ratio of diameters) (Figure 4).
- ✓
- UN 5: Node with no fatty and vascular hilum or aberrant vascular patterns, globular shape (loss of bipolar ratio of diameters), irregular margins (Figure 5).
3. Differential Diagnosis and Management of Atypical Lymph Nodes
- ✓
- UN 3 score: Benign. No further imaging is indicated at this time.
- ✓
- UN 4 or 5 score: US 6-week follow-up is recommended. If the lymph node has a lower score at the control, no further imaging is indicated at this time. If the score UN 4/5 remains, management is at the discretion of the attending procedural radiologist and/or surgeon based on laboratory or clinical evidence.
- ✓
- UN 3 score: The management is at the discretion of the attending procedural radiologist based on suspicion of lesion, pathology results, or a combination of these.
- ✓
- UN 4/5 score: Collegial management must be taken (surgeon and/or medical or radiation oncologist in consultation with radiologist), evaluating the choice between fine needle aspiration cytology (FNAC)/biopsy vs. imaging or clinical follow-up.
- ✓
- UN 3 score:
- Unsuspicious breast finding requires short-interval follow-up imaging with ultrasonography (with at least a 6-week delay).
- Suspicious breast finding requires standard work-up, including FNAC/biopsy.
- ✓
- UN 4/5 score: Node biopsy should be considered in the setting of high nodal metastatic risk and immediate histopathologic confirmation is necessary for timely patient management.
4. Conclusions
Author Contributions
Funding
Institutional Review Board Statement
Informed Consent Statement
Conflicts of Interest
References
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Fiaschetti, V.; Ubaldi, N.; De Fazio, S.; Cossu, E. Easy Scheme Outlining the Various Morphological and Vascular Abnormalities of the Lymph Node Structure Associated with Recent COVID-19 Vaccination, Each with a Different Clinical/Diagnostic Management. J. Pers. Med. 2022, 12, 1371. https://doi.org/10.3390/jpm12091371
Fiaschetti V, Ubaldi N, De Fazio S, Cossu E. Easy Scheme Outlining the Various Morphological and Vascular Abnormalities of the Lymph Node Structure Associated with Recent COVID-19 Vaccination, Each with a Different Clinical/Diagnostic Management. Journal of Personalized Medicine. 2022; 12(9):1371. https://doi.org/10.3390/jpm12091371
Chicago/Turabian StyleFiaschetti, Valeria, Nicolò Ubaldi, Smeralda De Fazio, and Elsa Cossu. 2022. "Easy Scheme Outlining the Various Morphological and Vascular Abnormalities of the Lymph Node Structure Associated with Recent COVID-19 Vaccination, Each with a Different Clinical/Diagnostic Management" Journal of Personalized Medicine 12, no. 9: 1371. https://doi.org/10.3390/jpm12091371
APA StyleFiaschetti, V., Ubaldi, N., De Fazio, S., & Cossu, E. (2022). Easy Scheme Outlining the Various Morphological and Vascular Abnormalities of the Lymph Node Structure Associated with Recent COVID-19 Vaccination, Each with a Different Clinical/Diagnostic Management. Journal of Personalized Medicine, 12(9), 1371. https://doi.org/10.3390/jpm12091371