Skip to main content

Table 2 Management of incidental unilateral axillary lymphadenopathy after recent (within 12 weeks) COVID-19 vaccination

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

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
  1. BI-RADS Breast Imaging Reporting and Data System, ACR American College of Radiology