medwireNews: A single-center study of women undergoing breast imaging after COVID-19 vaccination has revealed a higher than usual rate of axillary adenopathy.
“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 the researchers.
“Therefore, routine inquiring about recent history of COVID-19 vaccination is warranted,” they write in a research letter published in JAMA Oncology.
Among the 750 women who received at least one dose of a COVID-19 vaccine in the 90 days before having a screening or diagnostic mammogram at the authors’ institution between January 15 and March 22, 2021, axillary adenopathy was observed in 23 (3.1%), with just two women reporting symptoms.
There were no significant differences between women with and without adenopathy in terms of age, vaccine brand, or vaccine dose. But the median time from receipt of vaccine to mammography was significantly shorter in the former group, at 10 versus 18 days.
Saranya Chumsri and colleagues, from Mayo Clinic in Jacksonville, Florida, USA, also found a significant decrease in the rates of adenopathy with time from vaccination, falling from 5.3% at 1–14 days from vaccination to 2.9% at 15–28 days and 0.0% after 28 days.
Area under the receiver operating characteristic curve analysis indicated that a cutoff of 22.5 days after vaccination would avoid detecting vaccine-induced adenopathy in 72% of cases.
Findings on mammography included single and multiple enlarged nodes as well as adenopathy with soft tissue stranding. Additional ultrasonography was requested for 21 women, and 17 had had the procedure at the time of analysis, with findings ranging from mildly prominent nodes with a preserved fatty hilum to rounded nodes with apparent loss of a fatty hilum.
Two of the 17 women who underwent ultrasonography did not need further follow-up, while a repeat procedure with or without mammography within 3 months was recommended for 14 women and a biopsy for one woman with an ipsilateral breast cancer.
The researchers note the limitations of the study, such as the small sample size, but say: “As COVID-19 vaccination is rolling out around the world, this study offers timing considerations and possible findings for breast imaging following vaccination.
“Further studies are needed to guide future recommendations for following up with patients with adenopathy.”
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JAMA Oncol 2021; doi:10.1001/jamaoncol.2021.3127