E2076. Management of COVID-19 Unilateral Axillary Lymphadenopathy
  1. James Chalfant; David Geffen School of Medicine at University of California, Los Angeles
  2. Craig Wilsen; Stanford University School of Medicine
  3. Debra Ikeda; Stanford University School of Medicine
To investigate breast imaging radiologists’ management of unilateral axillary lymphadenopathy (UAL) after COVID-19 vaccination, following changes to Society of Breast Imaging (SBI) recommendations.

Materials and Methods:
To determine how UAL is managed following changes to SBI recommendations, a 26 question anonymous survey was developed by the California Breast Imaging Information Group (CBIIG) (a group representing California academic and community-based practices) and distributed to 12 CBIIG institutions in June 2022.

There were 10 responses (83% response rate, 10/12). All respondents (100%, 10/10) considered recent ipsilateral COVID-19 vaccination relevant in interpreting UAL; 70% (7/10) also considered other vaccinations relevant. Most (60%, 6/10) reported having practice-wide guidelines regarding UAL management. All practices either documented recent COVID-19 vaccinations or the information was readily available in the medical record; 40% (4/10) collected no information for other vaccines. When SBI first suggested delaying screening mammography (SM) after recent COVID-19 vaccinations, 80% (8/10) initially delayed screening. Although SBI stopped recommending delays, 30% (3/10) still required/suggested screening delays. When asked about UAL after recent vaccination on SM if the ipsilateral breast is normal, 40% (4/10) assign BIRADS 0, 30% (3/10) BI-RADS 2, and 30% (3/10) BI-RADS 3. Similarly, when the ipsilateral breast is normal on MRI, 30% (3/10) assign BIRADS 0, 50% (5/10) BI-RADS 2, and 20% (2/10) BI-RADS 3. On ultrasound (US), 40% (4/10) assign BI-RADS 2 and 60% (6/10) BI-RADS 3. If a BI-RADS 0 finding is seen in the ipsilateral breast on SM, 70% (7/10) assign the UAL BIRADS 0 while 30% (3/10) assign the UAL BI-RADS 3. When there is an ipsilateral suspicious finding on MRI, 80% (8/10) assign the UAL BI-RADS 4 and 20% (2/10) assign the UAL BI-RADS 0. For all respondents (100%, 10/10), suspicious breast findings on US prompt an ipsilateral UAL BI-RADS 4. The circumstances triggering a BI-RADS 4 or 5 for UAL were queried to explore risk stratification. Most reported they would typically consider assigning BI-RADS 4 or 5 to UAL if there was a suspicious finding in the ipsilateral breast (100%, 10/10), concurrent known ipsilateral breast cancer (100%, 10/10), and concurrent non-breast malignancy known to metastasize to the axilla (90%, 9/10). 50% (5/10) would also typically consider BI-RADS 4 or 5 for UAL if the patient had a history of breast cancer. Final disposition of BI-RADS 3 UAL was also evaluated. Most (80%, 8/10) recommend follow-up in 8 - 12 weeks. When UAL is improved but is still present on follow-up, 100% (10/10) assign BI-RADS 2. When UAL is unchanged on initial follow-up, 70% (7/10) assign BI-RADS 3 and 30% (3/10) assign BI-RADS 4.

Despite available guidelines, there is no consensus approach to UAL after vaccination, even among breast imaging radiologists in a single state.