COVID-19 Vaccination Associated With Axillary Adenopathy On Mammography

Author: By Lynda Williams, Senior medwireNews Reporter

medwireNews: Recent COVID-19 vaccination has been linked to an increased rate of axillary adenopathy in a US study of women undergoing screening or diagnostic mammography.

“As COVID-19 vaccination is rolling out around the world, this study offers timing considerations and possible findings for breast imaging following vaccination”, say Saranya Chumsri, from the Mayo Clinic in Jacksonville, Florida, USA, and fellow authors of a letter to JAMA Oncology.

The team reviewed medical records for 750 women who underwent mammography within 90 days of at least one COVID-19 vaccine dose between January and March 2021, 23 of whom had findings indicative of axillary adenopathy, such as a single or multiple enlarged lymph nodes, or adenopathy with soft tissue stranding.

Ultrasound examinations were recommended for 21 of the patients; results from the 17 ultrasounds reported so far include “mildly prominent nodes with a preserved fatty hilum” and “rounded nodes demonstrating apparent loss of a fatty hilum”, the researchers say. One patient with ipsilateral breast cancer had a negative biopsy and the authors remark that “the adenopathy was presumably vaccine induced.”

The likelihood of an abnormal mammogram was not related to patient age, type of vaccine or receipt of a first versus second vaccine dose, report Saranya Chumsri and colleagues.

But self-reported axillary swelling was significantly associated with abnormal imaging, being reported by two of 23 patients who had axillary adenopathy findings on their mammogram versus three of the 724 patients without adenopathy.

And the median time between vaccination and mammography was significantly shorter in patients with than those without adenopathy, at a median of 10 versus 18 days.

The rate of adenopathy fell significantly with increasing time from vaccination, from 5.3% of 283 patients who underwent mammography 1–14 days later, to 2.9% of 272 patients after 15–28 days and 0.0% of 195 patients whose mammography occurred more than 28 days after vaccination.

Using area under the ROC analysis, the team determined that a cutoff of 22.5 days from COVID-19 vaccination might avoid 72% of axillary adenopathy cases detected on mammography.

“While the incidence of COVID-19 vaccine-induced adenopathy in our study appeared to be low at 3% compared with 16% of self-reported axillary swelling in previous COVID-19 vaccine trials, this incidence is still higher than axillary adenopathy in otherwise normal mammography, which was reported as 0.02% to 0.04%”, say Saranya Chumsri et al.

“Therefore, routine inquiring about recent history of COVID-19 vaccination is warranted”, they state.

The team concludes: “Further studies are needed to guide future recommendations for following up with patients with adenopathy after vaccination and evaluating findings with other imaging modalities.”

Reference

Robinson KA, Maimone S, Gococo-Benore DA, et al. Incidence of axillary adenopathy in breast imaging after COVID-19 vaccination. JAMA Oncol; Advance online publication 22 July 2021. doi:10.1001/jamaoncol.2021.3127