Table 2 Management of incidental unilateral axillary lymphadenopathy after recent (within 12 weeks) COVID-19 vaccination
Patients | Clinical context | Management |
|---|---|---|
Without any history of breast cancer | No symptoms No suspicious breast findings at imaging | Unilateral axillary lymphadenopathy ipsilateral to the vaccination side should be classified as a benign (BI-RADS 2) finding and no further work-up should be pursued. Ultrasonography should be performed in case of symptoms of axillary lymphadenopathy more than 12 weeks after vaccination |
Breast imaging for breast symptoms No suspicious breast findings at imaging | Unilateral axillary lymphadenopathy ipsilateral to the vaccination side should be classified as a probably benign (BI-RADS 3) finding, and clinical follow-up of the axilla is indicated. In case of symptoms of axillary lymphadenopathy more than 12 weeks after vaccination, ACR BI-RADS recommendations should be followed for the management of axillary lymphadenopathy | |
With personal breast cancer history | Any context | Avoid vaccination at the breast cancer side. Manage unilateral axillary lymphadenopathy ipsilateral to the vaccination side according to overall nodal metastatic risk. For patients at low risk, define a case-by-case cautious management strategy. For patients at high risk, perform short-interval follow-up imaging with ultrasonography with at least a 12-week delay post vaccination, with node biopsy when necessary |