Axillary lymph node imaging in mRNA, vector-based, and mix-and-match COVID-19 vaccine recipients: ultrasound features

Axillary lymph nodes enlargement after Sars-CoV-2 vaccine in patients undergoing breast examination: a single-centre experience in 285 women

PURPOSE

To assess the incidence of axillary lymphadenopathy over established time ranges after COVID-19 vaccination and lymph node pathologic features (i.e. size increase and qualitative characteristics) in subjects undergoing axillary evaluation during a breast imaging examination.

METHODS AND MATERIALS

The institutional review board approved this prospective study.

INCLUSION CRITERIA

women undergoing mammography and breast ultrasound between July and October 2021; information about the COVID-19 vaccine and infection, if any.

EXCLUSION CRITERIA

known metastatic lymphadenopathy. Participants were divided into 5 subgroups according to time between vaccine and imaging: < 6 weeks; 7-8 weeks; 9-10 weeks; 11-12 weeks; > 12 weeks. Evaluation of axillary lymph nodes was performed with ultrasound. Descriptive statistical analysis was performed. p < 0.05 was considered significant.

RESULTS

A total of 285 women were included. Most of the patients underwent Moderna vaccine (n = 175, 61.4%). 63/285 patients had a previous history of breast cancer (22.1%). 13/17 (76.5%) patients with previous COVID-19 infection had no previous history of cancer, whereas 4/17 had a previous history of cancer (p < .001). 41/285 (14.4%) women showed lymphadenopathy, and they were significantly younger (46.9 ± 11.6 years) than women with borderline (54.0 ± 11.9 years) or no lymphadenopathy (57.3 ± 11.9 years) (p < .001). Lymphadenopathy and borderline lymphadenopathy were more frequently observed in the Moderna-vaccinated women and in the subgroup of patients evaluated < 6 weeks after vaccination (p < 0.001). The most common pathologic feature was cortical thickening, followed by complete or partial effacement of fatty hilum.

CONCLUSION

A lymphadenopathy within 12 weeks after vaccination is a common finding particularly in younger women and after Moderna vaccine and no further assessment should be required.

Breast Cancer Screening and Axillary Adenopathy in the Era of COVID-19 Vaccination

A 50-year-old woman with persistent axillary lymphadenopathy 17 weeks after COVID-19 vaccination was ultimately diagnosed with biopsy-proven benign reactive lymphadenopathy. In contrast, a 60-year-old woman with axillary lymphadenopathy and concurrent suspicious breast findings 9 weeks after COVID-19 vaccination was ultimately diagnosed with biopsy-proven metastatic breast carcinoma. This article reviews the current guidelines regarding breast cancer screening and management of axillary lymphadenopathy in the setting of COVID-19 vaccination.