Diagnostic Imaging's Weekly Scan: Jan. 22, 2021

COVID-19 Vaccine Adenopathies Mimic Breast Malignancies; Appendicitis, CT Exposure and Increased Cancer Risk; and MRI AI Tool for Prostate Cancer Recurrence Prediction

Welcome to Diagnostic Imaging’s Weekly Scan. I’m senior editor, Whitney Palmer.

Before we get to our featured interview this week with Dr. Katerina Dodelzon from Weill Cornell Medicine about COVID-19-vaccine related adenopathies that can mimic breast malignancies on imaging, here are the top stories of the week.

As more and more people get vaccinated for COVID-19, investigators from Weill Cornell have cautioned radiologists about a common side effect of vaccination – swollen lymph nodes. Based on their experience with four women in their institution – these adenopathies are showing up on breast imaging and can mimic breast malignancies. In fact, adenopathies can appear within two-to-four days in 11.6 percent of patients after one dose and 16 percent after two. The presentation on ultrasound and mammography has been the same for both the Moderna and Pfizer-BioNTech vaccines. In their study published in Clinical Imaging, they recommend that radiologists consider vaccine-related adenopathy as a differential diagnosis for unilateral axillary adenopathy and ask a patient about her COVID-19 vaccine history. Doing so could reduce unnecessary node biopsies. However, you should conduct repeated targeted ultrasound within four-to-12 weeks after the second vaccine dose, and if the adenopathy is still there, conduct an ultrasound-guided core needle biopsy to rule out malignancy.

More evidence emerged this week in the debate over whether radiation exposure from CT scans can increase the likelihood of cancer. In a study published in JAMA Surgery, investigators from South Korea looked at cancer incidence in patients who had a CT scan associated with acute appendicitis. They found that, in fact, the number of hematologic malignant neoplasms does increase with the number of CT scans performed, particularly in children under age 16. This can be problematic, they said, because appendicitis is common in children, and CT is increasing being used with the condition. By examining patient records from 825,820 individuals, they identified an incidence ratio rate of 1.26 for hematologic malignant neoplasm with the uptick beginning roughly 3 years post-CT exposure. The excess incidence ratio rate for all neoplasms reached 4.44, but in the CT group, specifically, it was 1.40 for leukemia. And, for patients under 16, it was 1.21 after one CT and 1.60 after two or more. The results, they said, underscored the need to abide by the Image Gently and Image Wisely guidelines.

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For prostate cancer, one of the most critical steps is being able to accurately identify which men will suffer a recurrence. According to a group from Case Western Reserve University, achieving that goal could get much easier thanks to their artificial intelligence tool, RadClip. They applied RadClip to pre-operative MRI scans from 200 patients who had undergone radical prostatectomy and found it can identify small heterogeneity and texture pattern differences both inside and outside the tumor. With that information, the team said, it is easier to estimate and predict post-surgical outcomes. Based on their findings, RadClip outperforms existing predictive strategies, such as Cancer of the Prostate Risk Assessment and the genomic-based Decipher® Prostate Cancer Test.

And, finally, this week, as mentioned earlier, anecdotal reports were published this week about COVID-19 vaccine-related adenopathies that can mimic malignant breast abnormalities. For the details of the study, Diagnostic Imaging spoke with Dr. Katerina Dodelzon, assistant professor of radiology at Weill Cornell Medicine. Dodelzon, who is also a board-certified breast imager, discussed the findings of her team’s experience with the four women included in the study and what it means for radiologists, both in breast imaging and other sub-specialties. Here’s what she had to say.