Estrogen receptor (ER)-positive metastatic breast cancers after a period of response to tamoxifen develop resistance, and the disease progresses clinically. Domination of partial agonistic activity of tamoxifen over its antagonist activity has been implicated as one of the mechanisms for acquired tamoxifen resistance. Six patients with ER-positive, human epidermal growth factor receptor 2 (HER2)-negative metastatic breast cancer who were treated with tamoxifen withdrawal were retrospectively reviewed. Three patients were premenopausal and three were postmenopausal at the beginning of this treatment. Three patients had stage IV disease and three had recurrent breast cancers with median disease-free intervals of 153 months. The treatment lines of tamoxifen therapy were first-line in two, second-line in two, and third-line in one patient. One patient had relapsed during adjuvant tamoxifen therapy. The median duration of tamoxifen therapy was 16 months. The metastatic disease sites at the time of tamoxifen withdrawal were lymph nodes in six, bone in three, chest wall in one, lung in two, pleura in one, and liver in one patient. The median duration of tamoxifen withdrawal was 6.5 months (range 5-> 23 months). Five of six patients had clinical benefits with tamoxifen withdrawal: partial response in one, long stable disease (SD) in four, and SD in one patient. Five patients were treated with aromatase inhibitors after tamoxifen withdrawal. Two patients had metastatic lymph nodes examined by multi-gene panel testing, and both of their tumors had the AKT1 E17K somatic mutation. One patient also had a BRCA 1 germline mutation. Tamoxifen withdrawal at the time of tumor progression while on treatment might be an important treatment option, especially for women with highly endocrine-responsive disease.
575 Background: COVID-19 vaccination-related lymphadenopathy is a frequent imaging finding that may be indistinguishable from malignant nodes and can lead to diagnostic difficulties in patients with cancer or healthy individuals on cancer screening. However, no prospective trials regarding COVID-19 vaccination-related lymphadenopathy following a booster shot have been conducted. The purpose of this study was to determine the incidence and imaging characteristics of COVID-19 vaccination-related axillary lymphadenopathy and assess the recovery period following a booster shot. Methods: We prospectively enrolled healthy women working at St. Luke’s International Hospital, who would receive the third shot of the Pfizer-BioNTech COVID-19 vaccine between December 6 and 28, 2021. Women with a history of cancer, atopic dermatitis, auto-immune disease, or axillary surgery were excluded. All participants underwent ultrasound (US) examinations for the bilateral axilla at baseline (prior to the third shot), early phase (1–3 days after the shot), and late phase (6 weeks after the shot) if lymphadenopathy was detected at the early phase. We evaluated the incidence and US characteristics of lymphadenopathy. As for US characteristics mimicking a malignant node, focal cortical thickening, absence of the echogenic hilus, and vascularity were examined. In this study, abnormal lymphadenopathy was defined as [1] an increase in the short-axis size by more than 2 mm compared with the baseline, [2] an increase in the number of nodes with short-axis diameter more than 5 mm, and [3] demonstrating US characteristics mimicking malignant nodes. Results: A total of 100 women were enrolled in this study. The median age was 41 years (range 23–63). Abnormal axillary lymphadenopathy on the vaccinated side was observed in 59% of participants in the early phase and 8% in the late phase. In the contralateral axilla, abnormal lymphadenopathy was observed in 1% of participants in the early phase and 2% in the late phase. The median short-axis size of ipsilateral abnormal lymphadenopathy was 7.6 mm in the early phase and 5.7 mm in the late phase. In the early phase, US characteristics mimicking malignant nodes were observed, including focal cortical thickening in 54% of participants, absence of the echogenic hilus in 16%, and hypervascularity in 33%. Conclusions: COVID-19 vaccination-related axillary lymphadenopathy indistinguishable from malignant nodes was observed in more than half of the participants compared with the baseline, which improved in most cases within 6 weeks after the latest booster shot. To avoid a diagnostic conundrum, patients with breast cancer should be vaccinated on the arm contralateral to the cancer side. It is recommended that non-urgent imaging screening for the axilla should be scheduled after 6 weeks following the latest vaccination.
Background: COVID-19 vaccination-related lymphadenopathy is a frequent imaging finding which may be indistinguishable from malignant nodal involvement and lead to diagnostic difficulties in patients with cancer or healthy individuals on cancer screening. An expert panel of the leading cancer centers in United States recommended routine imaging examinations should be scheduled at least 6 weeks after the final vaccination to allow for any reactive lymphadenopathy to resolve. However, there were no prospective trials regarding COVID-19 vaccination-related lymphadenopathy and the evidence was so limited. The purpose of this study was to determine the incidence and imaging characteristics of COVID-19 vaccination-related axillary lymphadenopathy and assess the recovery period. Methods: We prospectively enrolled healthy women working at the St. Luke’s International Hospital who received Pfizer COVID-19 vaccination within 8 weeks before enrollment between May 10th and 27th, 2021. Women with a history of any type of cancer or axillary surgery, active atopic dermatitis and auto-immune disease were excluded. Participants underwent ultrasound examinations for bilateral axilla at the enrollment. Lymphadenopathy was defined as demonstrating an enlarged node(s) with more than 5mm in short axis by ultrasound imaging in this trial. As for imaging characteristics, status of cortical thickening, echogenic hilus and vascularity of lymph nodes were evaluated. Other side effects by vaccination were assessed by a questionnaire. If lymphadenopathy was detected, we followed the participant by ultrasound examination every three weeks until the lymphadenopathy was resolved. We evaluated the incidence rate and imaging characteristics of lymphadenopathy detected by ultrasound examination, and the recovery period required for improvement of the lymphadenopathy. We also validated the association of the lymphadenopathy with the participant characteristics and other side effects. Results: A total of 135 women were enrolled in this study. Participants' median age was 37 years (range 23-63). Median time from the latest vaccination to the enrollment was 45 days (range 8-56). In the ultrasound examination at enrollment, axillary lymphadenopathy was observed in 67 participants (50%) on the injected (ipsilateral) side. In the contralateral axilla, 13 participants (10%) showed lymphadenopathy. In the ipsilateral axilla, the number of enlarged node(s) was 1 node in 25 cases (19%), 2 nodes in 24 cases (18%), 3 nodes in 13 cases (10%), 4 nodes in 4 cases (3%) and 5 nodes in 1 case (1%). Regarding the ipsilateral enlarged lymph node, focal cortical thickening was observed in 58 cases (43%) and the absence of the echogenic hilus was observed in 15 cases (11%). Hypervascularity was observed in 15 cases (11%). Incidence of the lymphadenopathy was not statistically correlated with participant’s age or incidence of fever due to vaccination. At 6 weeks after the latest vaccination, the rate of ipsilateral axillary lymphadenopathy was 48%, 40% at 8 weeks, and 6% at 12 weeks. In participants with lymphadenopathy, median recovery period to resolve the lymphadenopathy was 75 days from the latest vaccination. Conclusion: A half of participants showed COVID-19 vaccination-related axillary lymphadenopathy and the imaging characteristics were often indistinguishable from malignant nodal involvement. Therefore, patients with breast cancer should be vaccinated on the contralateral arm to the cancer side to avoid diagnostic conundrum. The lymphadenopathy was commonly observed even in 8 weeks, and mostly resolved after 12 weeks from the vaccination. Therefore, non-urgent imaging examinations such as screening would be recommended to be scheduled at least 12 weeks following the latest vaccination. Citation Format: Kumiko Kida, Hiroko Tsunoda, Risa Kasahara, Chika Tsutsumi, Akiko Numata, Yuri Takehara, Atsushi Yoshida, Junko Takei, Naoki Hayashi, Daiki Kobayashi, Hideko Yamauchi. Prospective ultrasonographic surveillance study for incidence and recovery period of COVID-19 vaccination-related axillary lymphadenopathy [abstract]. In: Proceedings of the 2021 San Antonio Breast Cancer Symposium; 2021 Dec 7-10; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2022;82(4 Suppl):Abstract nr P1-01-01.
日臨外会誌 82( 2 ) ,339-343,2021 DepartmentofBreastSurgery 1) ,DepartmentofRadiology 2) ,DepartmentofPathology 3) ,St.LukesInternationalHospital A56-year-oldpatientpresentedwithahypoechoicmassinthebreasts.Thepatienthadahistoryof invasivemucinouspT1cN0M0StageIcarcinomainthelowerouterquadrantofherleftbreastandhad undergonelumpectomyandsentinellymphnodebiopsy,followedbypostoperativeirradiationtherapyand endocrinetherapy.Palpation,mammography,andsonographysuggestedmetachronousipsilateralbreast cancer.Theneedlebiopsyspecimenshowedproliferationofspindle-shapedcellswithlownuclearatypia andlowmitoticcounts.Radiologicalfindingsrevealedagrowingheterogeneousmass.Basedonthecombined imaging and biopsy results, desmoid-type fibromatosis was suspected. Tumor resection was performed with a sufficient surgical margin. Postoperative diagnosis based on the surgical specimen confirmeddesmoid-typefibromatosis.Desmoid-typefibromatosisisdifficulttodiagnoseusingsmallbiopsy samples;thus, appropriate treatment should be administered based on pathological and radiological assessments.
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