Vaccine Adenopathy Pattern on Breast MRI Supports Benign Assessment

COVID-19 vaccine-related adenopathies are a known entity, but in many instances, they can still give providers pause about what they’re seeing on a screening breast exam.

In a new article published July 26 in Clinical Imaging, a team of investigators from the Diagnostic Center for Women in Miami shared a pattern on screening that, when visualized, can bolster a radiologist's confidence in rendering a benign assessment.

“Knowing that the COVID-19 vaccine is administered intramuscularly in the deltoid muscle of the upper arm and understanding the lymphatic drainage pattern of the breast and upper extremity,” said the team led by Michael J. Plaza, M.D., a radiologist at the Center, “we suggest that a pattern of unilateral axillary lymphadenopathy involving the lateral, central, and/or apical groups with relative sparing of the anterior group is typical for vaccine-related lymphadenopathy.”

For their study, they used findings from a screening breast MRI conducted on a 63-year-old asymptomatic female patient. She received her second vaccine dose in her left arm six days prior to the scan.

These were their findings:

• No suspicious enhancement present in the left breast.
• Morphologically abnormal high level II/III axillary lymph nodes (central and apical group) in the presence of normal low level I axillary lymph nodes (anterior group)

“Identifying this pattern of unilateral axillary adenopathy in the setting of ipsilateral COVID-19 vaccine administration and a negative screening breast MRI allows one to confidently give a benign assessment in keeping with a pragmatic approach,” the team said.

Consequently, they added, radiologists may be able to reduce the number of unneeded follow-ups and/or biopsies. This knowledge also pushes back against the practice of delaying breast MRI screening due to recent vaccinations.

Still, the team cautioned, providers should treat every instance with patients who have a history of cancer as an individual experience. Determine the course of action and treatment with a multi-disciplinary team based on cancer type, lymph node drainage pathway, and metastasis risk.

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