Some patients who receive the COVID-19 vaccine experience axillary adenopathy that is visible on breast imaging; therefore, a team of radiologists from Harvard Medical School and Massachusetts General Hospital outlined an approach for managing this concern. A description of their approach was recently published as a clinical perspective in the American Journal of Roentgenology.
The team, including Constance D. Lehman, MD, PhD, and colleagues, presented their strategy for addressing axillary adenopathy following COVID-19 vaccination. It incorporates assessing clinical presentation, vaccination delivery, and imaging findings.
In their practice, adenopathy is reported as benign if findings on screening with mammography or magnetic resonance imaging are restricted to unilateral axillary adenopathy occurring on the same side as COVID-19 vaccination administered in the deltoid muscle during the previous 6 weeks. Further imaging in this case may not be indicated if nodes are not palpable after 6 weeks following the final dose of vaccine. However, if axillary adenopathy is palpable, they recommend clinical follow-up.
If clinical concerns continue beyond 6 weeks after completion of vaccination, Dr Lehman and colleagues recommended further imaging. In addition, they recommended further imaging and vaccination (administered in the thigh or contralateral arm) for patients with a recent breast cancer diagnosis in the pre- or peritreatment setting.
The team noted that the COVID-19 pandemic has been linked to disruptions in breast cancer screening, which may lead to more later-stage diagnoses. This approach focuses on supporting COVID-19 vaccination, limiting delays regarding breast imaging exams, and limiting the use of imaging or biopsies for transient adenopathy arising from deltoid muscle vaccination.
“In this setting, we believe our model can avoid reducing or delaying vaccinations and avoid further reduced or delayed breast cancer diagnoses based on confusion amongst patients and/or their providers,” Dr Lehman and colleagues explained in their report.
Disclosure: Some authors declared affiliations with and receipt of funding from the pharmaceutical industry. Please refer to the original article for a full list of disclosures.
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. AJR Am J Roentgenol. Published online February 22, 2021. doi:10.2214/AJR.21.25688