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Oxelary adenopathy, or swelling under the armpit, has been reported by women after receiving the Pfizer-BioNTech and Moderna COVID-19 vaccines, but it is also a common symptom of breast cancer.
Therefore, clinicians should consider the recent COVID-19 vaccination history in the differential diagnosis of patients who have unilateral axillary adenopathy, according to a new article.
“We noticed an increasing number of patients with swollen lymph nodes on only one side / one armpit offered for mammography or ultrasound, and some women who felt these swollen nodes,” says author Katerina Dodelzon, MD, assistant professor of clinical clinics. radiology, Weill Cornell Medicine, New York City.
‘Historically, swollen lymph nodes on only one side are relatively rare and are an uncommon occurrence in mammography screening – seen only 0.02% to 0.04% of the time – and this is a sign that a radiologist warns about the to rule out the presence of breast malignancy thereon. side, ‘she added.
In an article published in Clinical imaging, Dodelzon and colleagues describe four cases involving women who received a COVID-19 vaccine and then underwent breast examination. In describing these cases, the authors sought “to inform the medical community to consider this benign and self-resolving diagnosis in the context of the worrying presentation of unilateral axillary adopy.”
They hope they will reduce unnecessary biopsies and reassure patients.
Adenopathy has been reported in association with other vaccines, such as the bacillus Calmette-Guérin vaccine, influenza vaccine and the human papillomavirus vaccine, said Jessica WT Leung, MD, president of the Society of Breast Imaging (SBI).
“It is too early to say whether there is anything else to the COVID-19 vaccines,” Leung said. He is also Professor of Diagnostic Radiology and Deputy Chair of Breast Imaging at the University of Texas, Anderson Cancer Center, Houston, Texas.
“The two vaccines currently in use – Pfizer and Moderna – are both mRNA vaccines, and it is unknown whether it will elicit a stronger immune response,” she said. “If the Johnson & Johnson and AstraZeneca vaccines are available, it will be interesting to see if they respond so strongly, because they are not mRNA vaccines. At the moment we have no information to do not say. “
Leung also noted that these latest vaccine reactions may receive more attention because ‘it’s COVID-19 related, and everything related to COVID-19 gets more attention.
“It can also be more noticeable due to the large number of people being vaccinated within a short period of time in an effort to limit the pandemic, and this is not the case with the other vaccines,” she said.
New recommendations from SBI
The SBI recently issued recommendations to clinicians that women who experience axillary adenopathy and who have recently been vaccinated on the same side that adenopathy occurs be followed for several weeks to see if the lymph nodes return to normal, rather than undergoing a biopsy. .
“Many practices now regularly examine the history of recent vaccination and on what side it was given,” Dodelzon said. She stressed that women should feel empowered to share history if they are not asked.
“If you let a mammography technologist or a breast sculptor know that you have recently been vaccinated, and on what side it provides the breast sculptor with a more accurate context to interpret the results,” she said.
In addition, the SBI recommends that women, if possible, schedule routine mammography before the first dose of COVID-19 vaccine or 4 to 6 weeks after the second dose to prevent a false positive finding.
“We want to emphasize that the examination of mammography is very important, and to make it possible around the vaccine,” Leung said. “But that may not be possible, as most of us do not have the choice to get the vaccine.”
If it is not possible to reschedule the mammogram or vaccine, Leung recommends that women notify the institution that they have recently received a COVID-19 vaccine. “We are currently recommending a follow-up in 4 to 12 weeks,” she said. “The swelling may subside earlier, maybe even within 1 to 2 weeks, but we generally recommend waiting at least 4 weeks to catch the majority of women.”
Differences between the vaccines?
According to reports from the Centers for Disease Control and Prevention (CDC), the frequency with which armpit adenopathy occurs as a side effect differs from the two COVID-19 vaccines.
For the Moderna vaccine, axillary adenopathy to the vaccination arm was the second most common local reaction, with 11.6% of recipients aged 18 to 64 reporting it after the first dose, and 16.0% having it after the second logged in. The average duration of this adenopathy was 1 to 2 days.
For the Pfizer-BioNTech COVID-19 vaccine, the CDC notes that reports of adenopathy have been balanced between the vaccine and placebo groups, concluding that adenopathy is likely to be related to the vaccine.
The average duration of adenopathy was about 10 days.
Adenopathy was reported for both vaccine groups within two to four days after vaccination, according to the CDC.
Details from the cases reported by Dodelszon and colleagues, however, give a somewhat different picture. In case 1, for example, the patient detected unilateral axillary adenopathy himself 9 days after receiving the first dose of Pfizer-BioNTech vaccine. In case 3, the time between receiving the Moderna vaccine and detecting adenopathy was 13 days.
In both of these cases, the time was much longer than the average duration of 1 to 2 days observed by the CDC. According to the authors, radiologists understand that the side effect can occur up to several weeks after the vaccination of COVID-19 if they take the vaccination of the patient.
In cases 2 and 4, the axillary adenopathy was accidentally observed during mammography, so it is unclear when the reaction started after receiving the COVID-19 vaccine.
The authors and Leung did not disclose any relevant financial relationships.
Clin Imaging. Published January 18, 2021 online. Full text
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