Purpose: We performed a retrospective study in our community multispecialty clinic to quantify abnormal unilateral axillary lymphadenopathy (UAL) incidence on screening mammograms in patients undergoing recent ( < 6 weeks prior) COVID-19 vaccination, evaluate for any known adverse outcomes in UAL patients classified as BI-RADS 2, and determine how many women with a screening- detected cancer also had a recent vaccine.
Materials and Methods: Materials and
Methods: After the 1/2021 SBI Recommendations on Axillary Adenopathy/COVID-19 Vaccination, we began recording screening mammography patient COVID-19 vaccination date and arm laterality. We did not delay/reschedule screening due to vaccinations. Retrospectively, we queried the electronic medical record for women undergoing screening mammography at one of our seven sites between 2/1/21 - 3/31/21 who also underwent first/second COVID-19 vaccination within 6 weeks of screening. Post-vaccination mammograms were reviewed by 2 MQSA certified mammographers and classified as no abnormal UAL or abnormal UAL possibly secondary to vaccination. Equivocal cases were decided by consensus. For abnormal UAL, we reviewed the EMR for persistent or abnormal axillary UAL, axillary swelling/pain, new diagnosis of lymphoma, breast cancer or other malignancy. We also documented the number of screening-detected breast cancers from 2/1/21-4/30/21, recording patient vaccination status.
Results:
Results: Of 6,179 patients undergoing screening exams 2/1/21-3/31/2021, 1,621 (26.2%) had a recent ( < 6 weeks) COVID-19 vaccine, 10 of whom were excluded due to inability to visualize the axilla. Of the 1,611 patients comprising the study, 48 (3%) patients had abnormal UAL. No UAL-related adverse outcomes have been reported as of September 2021 (six-month follow up). During 2/1/2021-4/30/202, there were 58 mammographically discovered breast cancers, 29 (50%) of whom also had a < 6 week COVID-19 vaccination.
Conclusion:
Conclusion: In our large screening cohort, the abnormal UAL incidence on screening mammography < 6 weeks of a first/second COVID-19 vaccination dose was 3%. To date, no patient with presumed reactive ipsilateral UAL related to vaccination alone has had an adverse outcome or persistent medical concern related to vaccination-related UAL. In 58 mammographically-detected breast cancers, 50% had recent ( < 6 weeks) vaccination, but without delay of diagnosis since we did not reschedule women due to vaccination status.
Clinical Relevance Statement: Clinical Relevance: COVID-19 vaccination resulted in a 3% incidence of abnormal unilateral axillary lymphadenopathy in a large screening cohort. 50% of screen-detected cancers occurred in women who had recent vaccinations. Our data indicate that facilities continuing screening after vaccination will encounter few UAL cases, and not delay screen-detected cancer diagnoses.
