Axillary Lymphadenopathy After COVID-19 Vaccination in a Woman With Breast Cancer

Abstract

A 39-year-old healthy woman without family history of malignancy found a mass in her right breast at 38 weeks of pregnancy. Prior to delivery, she underwent diagnostic ultrasound of the right breast, which showed a possible mass in the location of the palpable lesion that was most consistent with a normal island of fibroglandular tissue. Follow-up mammogram and ultrasound of the right breast (without axillary evaluation) were performed 6 months later, which showed anirregular17-mmmasswithassociatedpleomorphiccalcificationsinthesamearea.Ultrasoundguided biopsy was performed. Pathology showed high-grade, estrogen receptor-positive ductalcarcinomainsitu(DCIS).Onpostbiopsyphysicalexamination,thepatienthadapalpable2.5-cm right breast mass at the 3-o'clock position without palpable axillary lymphadenopathy.Surgical treatment with lumpectomy was recommended, and breast magnetic resonance imaging (MRI) was performed prior to surgery to evaluate the extent of disease (Figure). Axial T2-weighted MRI at the level of the axilla revealed edema surrounding 2 enlarged, morphologically abnormal right level-1 axillary lymph nodes; axial postcontrast T1 fat-saturated MRI of the right breast revealed an irregular mass with irregular margins at the site of biopsy-proven DCIS. The patient reported receiving her second dose of COVID-19 vaccine (Pfizer-BioNTech) in the right arm the day before the breast MRI. Diagnosis Vaccination-associated reactive lymphadenopathyWhat to Do Next D. Perform right axillary ultrasound now, with intent to biopsy enlarged lymph nodes

What have we learned about the allergenicity and adverse reactions associated with the severe acute respiratory syndrome coronavirus 2 vaccines: One year later

“…For patients with cancer, it is recommended that vaccination occurs contralateral to any known adenopathy or tumor pathology. 47,48 Studies have also reported neuropsychiatric symptoms with important morbidity and mortality, such as depression, anxiety, and altered mental status. 46 In very rare instances (approximately 1%), ischemic and hemorrhagic strokes and seizures have been reported.…”

Axillary adenopathy detected on breast MRI following COVID-19 vaccination: outcomes and follow-up recommendations

“…At the time of follow-up US, the adenopathy had resolved in 54/91 (59%) of patients. Patients with resolved adenopathy had longer times between vaccination and US (16 weeks [7–24] versus 10 weeks [4–18], p = 0,04) and between MRI and US (5 weeks [2–9] versus 2 weeks, 1. , 2.…”

“…The COVID-19 vaccine has been shown to cause unilateral axillary adenopathy. 1 With increasing COVID-19 vaccine availability and recommendations for additional booster vaccinations to combat COVID-19 variants, the medical community will continue to be challenged with management recommendations for axillary adenopathy in the setting of a recent COVID-19 vaccine. In breast imaging, unilateral axillary adenopathy is typically considered suspicious for locally advanced breast cancer.…”

“…In breast imaging, unilateral axillary adenopathy is typically considered suspicious for locally advanced breast cancer. 1 However, studies have shown that axillary adenopathy following a COVID-19 vaccination is a relatively common finding with incidence reported up to 44% on breast imaging examinations. 2.…”

COVID-19 Vaccine-Associated Lymphadenopathy in Breast Imaging Recipients: A Review of Literature

“…Lengthening imaging follow-up to 12-16 weeks after the second dose may reduce unnecessary biopsy recommendations. 25 Lam and Flanagan [ 34 ] Axillary lymphadenopathy after COVID-19 vaccination in a woman with breast cancer. Case report of a 39-year-old woman with known right breast malignancy who underwent MRI before lumpectomy, showing right axillary LAP does not present on prior imaging.…”