ARRS 2022 Abstracts

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E1821. Management of Axillary Adenopathy in the Era of COVID-19 Vaccination: A Case-Based Approach
Authors
  1. Haydee Ojeda-Fournier; UC San Diego Health
  2. Vivian Lim; UC San Diego Health
  3. Rebecca Rakow-Penner; UC San Diego Health
  4. William Ladd; UC San Diego Health
  5. Mohammad Eghtedari; UC San Diego Health
Background
Axillary adenopathy (ALDN) is a symptom of the underlying disease process and is seen in less than 1% of screening mammograms. Differential considerations include infection, inflammation, and malignancy. In this case-based presentation, we present several scenarios, with management strategies and pathology correlation of patients presenting with symptomatic and screening-detected ALDN in the era of COVID-19 vaccination. Current literature review and guidelines are shown.

Educational Goals / Teaching Points
By the end of this educational exhibit, the learner will know the imaging features of ALDN by mammogram, US, and MRI;identify the concerning clinical and imaging features that warrant further evaluation; and describe the role of imaging in the assessment of unilateral adenopathy.

Key Anatomic/Physiologic Issues and Imaging Findings/Techniques
Morphologic assessment of adenopathy is reviewed. Unilateral v. bilateral adenopathy and their implications are discussed. Differential considerations including infection, inflammation, and malignancy are reviewed. Recommended management of axillary adenopathy in patients with recent COVID-19 vaccination will be illustrated as well as suggested recommended management of axillary adenopathy in patients with a recent diagnosis of breast cancer and COVID-19 vaccination. Cases include mammographic findings, ultrasound findings, and MRI findings. Metastatic disease to the axilla and clinical management is reviewed. This presentation is cased-based with an opportunity for self-assessment.

Conclusion
Although ALDN is unusual at screening mammography, it is important to identify adenopathy because it can be a sign of breast cancer, other malignancies, or systemic disease. Staging of the axilla is one of the critical tasks performed by breast imagers and the identification of metastatic disease to the axilla changes the clinical management of breast cancer. In the era of COVID-19 vaccination, there have been adjustments to the management of axillary adenopathy found at both screening mammography and diagnostic breast imaging evaluation.