Purpose: To assess clinical practice patterns regarding management of COVID-19 vaccine related lymphadenopathy among breast imaging radiologists.
Materials and Methods: An online survey was created and distributed to members of the Society of Breast Imaging (SBI). Questions encompassed appointment timing and image interpretation when lymphadenopathy is encountered in the setting of COVID-19 vaccination. The survey was open from 04/28/2021 to 05/14/2021. Participation was voluntary and responses anonymous.
Results: A total of 335 SBI members completed the survey. The most common practice types were private practice (57%) and academic (37%). Regarding scheduling of screening in the setting of recent vaccination, 63% responded that screening should not be delayed while 37% responded that screening should be delayed. Among those that advocated delay, the most frequently recommended follow-up intervals were 4-6 weeks (44%) and 6-8 weeks (30%) after final vaccination.
For lymphadenopathy identified in an otherwise negative screening mammogram after recent ipsilateral vaccination, the most commonly reported assessments were BI-RADS 0 (44%), BI-RADS 2 (42%), and BI-RADS 3 (10%). Of those who responded BI-RADS 0 or 3, 65% recommended immediate diagnostic work-up and 32% recommended a delay. Of those who recommended delay, the most frequently suggested follow-up intervals were 6-8 weeks (32%) and 4-6 weeks (25%) after final vaccination.
If the screen-detected lymphadenopathy was confirmed at diagnostic imaging, 91% reported that the appropriate assessment was BI-RADS 3. Recommended follow-up intervals varied widely, including 4-6 weeks (16%); 6-8 weeks (25%), 8-10 weeks (10%), 10-12 weeks (22%), and >12 weeks (18%). If lymphadenopathy was unchanged at follow-up, 63% recommended biopsy, 30% recommended additional follow-up, and 7% had other recommendations.
For palpable axillary symptoms after ipsilateral vaccination, if lymphadenopathy was identified on diagnostic imaging, the most commonly reported assessments were BI-RADS 3 (73%) and BI-RADS 2 (16%). For BI-RADS 3 assessments, the recommended follow-up intervals varied widely, including 4-6 weeks (16%); 6-8 weeks (24%), 8-10 weeks (16%), 10-12 weeks (24%), and >12 weeks (14%).
Conclusion: Breast imaging practice patterns in the setting of COVID-19 vaccination vary widely, with differing BI-RADS assessments for lymphadenopathy and disparate follow-up recommendations. Inconsistent practice patterns may reflect uncertainty regarding the appropriate management of this relatively new phenomenon and the need for more evidence-based guidelines.
Clinical Relevance Statement: Patients will continue to receive COVID-19 immunizations and boosters for the foreseeable future. Therefore, a more systematic and evidence-based approach to vaccine related lymphadenopathy at breast imaging is needed.
