Axillary lymphadenopathy at the time of COVID-19 vaccination: ten recommendations from the European Society of Breast Imaging (EUSOBI).

Schiaffino, Simone; Pinker, Katja; Magni, Veronica; Cozzi, Andrea; Athanasiou, Alexandra; Baltzer, Pascal A. T.; Camps Herrero, Julia; Clauser, Paola; Fallenberg, Eva M.; Forrai, Gábor; Fuchsjäger, Michael H.; Helbich, Thomas H.; Kilburn-Toppin, Fleur; Kuhl, Christiane K.; Lesaru, Mihai; Mann, Ritse M.; Panizza, Pietro; Pediconi, Federica; Pijnappel, Ruud M.; Sella, Tamar

Unilateral axillary lymphadenopathy is a frequent mild side effect of COVID-19 vaccination. European Society of Breast Imaging (EUSOBI) proposes ten recommendations to standardise its management and reduce unnecessary additional imaging and invasive procedures: (1) in patients with previous history of breast cancer, vaccination should be performed in the contralateral arm or in the thigh; (2) collect vaccination data for all patients referred to breast imaging services, including patients undergoing breast cancer staging and follow-up imaging examinations; (3) perform breast imaging examinations preferentially before vaccination or at least 12 weeks after the last vaccine dose; (4) in patients with newly diagnosed breast cancer, apply standard imaging protocols regardless of vaccination status; (5) in any case of symptomatic or imaging-detected axillary lymphadenopathy before vaccination or at least 12 weeks after, examine with appropriate imaging the contralateral axilla and both breasts to exclude malignancy; (6) in case of axillary lymphadenopathy contralateral to the vaccination side, perform standard work-up; (7) in patients without breast cancer history and no suspicious breast imaging findings, lymphadenopathy only ipsilateral to the vaccination side within 12 weeks after vaccination can be considered benign or probably-benign, depending on clinical context; (8) in patients without breast cancer history, post-vaccination lymphadenopathy coupled with suspicious breast finding requires standard work-up, including biopsy when appropriate; (9) in patients with breast cancer history, interpret and manage post-vaccination lymphadenopathy considering the timeframe from vaccination and overall nodal metastatic risk; (10) complex or unclear cases should be managed by the multidisciplinary team.

SENTINEL lymph node biopsy; LYMPHADENITIS; COVID-19 vaccines; BREAST imaging; VACCINATION complications; BREAST cancer; BREAST exams

Insights into Imaging, 2021, Vol 12, Issue 1, p1

1869-4101

Academic Journal

10.1186/s13244-021-01062-x