SBI Publishes Management Guidance for COVID-19 Vaccine-Related Adenopathies

January 26, 2021

With more axillary adenopathies likely to present on breast imaging, Society of Breast Imaging experts offer guidance for best management during the pandemic.

In response to evidence published last week in Clinical Imaging that the two approved COVID-19 vaccines can potentially lead to axillary adenopathies that can mimic breast malignancies, the Society of Breast Imaging (SBI) has published management guidelines for affected patients.

Although these adenopathies are rare on normal screening mammograms, appearing on 0.02 percent-to-0.04 percent of studies, SBI experts said, breast imagers need to be aware they will likely be more common in the coming months.

“As national vaccination efforts are underway, women with a recent COVID-19 vaccine may present for diagnostic workup for newly palpable axillary adenopathy or have new axillary adenopathy identified on routine screening mammography or ultrasound,” they said in a published statement, advising breast radiologists they will encounter more axillary adenopathies as vaccine rates increase.

According the data from vaccine manufacturers Moderna and Pfizer-BioNTech, these adenopathies can occur in 11.6 percent of patients who receive the first-round vaccine dose and in 16 percent of those who receive the second dose. They appear within two-to-four days and can last for up to 10 days. Post-vaccine adenopathies that have appeared on mammography have, thus far, been unilateral.

To ensure that women undergoing breast imaging are properly managed during this time of the pandemic, the SBI offered five guidelines.

When possible – being sure not to unduly delay care – schedule screening exams before the first vaccine dose or four-to-six week after the second dose.
On patient intake forms, ask for COVID-19 vaccine status, as well as timing and side of vaccination. To reduce patient anxieties, considering including this statement: “Vaccines of all types can result in temporary swelling of the lymph nodes, which may be a sign that the body is making antibodies in response, as intended.”
Attached BI-RADS category 0 to unilateral axillary adenopathy visualized on screening exams, allowing for more evaluation of the ipsilateral breast and medical history documentation, such as the COVID-19 vaccine.
After appropriate diagnostic work-up for unilateral axillary adenopathy in women who were vaccinated in the ipsilateral upper extremity within four weeks prior to screening, consider a follow-up exam between four-to-12 weeks post-second dose.
Consider a lymph node sampling to rule out breast and non-breast malignancy if the axillary adenopathy lingers.

SBI experts cautioned that guidance for assessing and managing these axillary adenopathies could be subject to changes as more information about the COVID-19 vaccines become available. Recommendations for other vaccines will also be incorporated as they are approved for use.

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