New approach may reduce unnecessary evaluation of swollen lymph nodes after COVID-19 vaccination

Inflammation of the lymph nodes in the area of ​​the armpit is a common response to COVID-19 vaccines, but when seen on mammograms, they can be misdiagnosed for nodes that have been removed due to cancer. In some cases, the nodes have a biopsied to confirm that they are not cancer.

To avoid confusion from patients and their providers, and to avoid delays in vaccines or mammograms recommended during pandemic, radiologists at Massachusetts General Hospital (MGH) have published a method for regulating what is commonly expected as vaccine program ramps. up. The approach is described in the American Journal of Roentgenology.

We had begun to see more patients in our breast imaging clinic with enlarged lymph nodes on mammography, ultrasound, and magnetic resonance imaging. And we noticed that they were coming to our clinic after a recent COVID-19 vaccine. We spoke to our colleagues in primary care and in our dedicated breast cancer clinics and realized that we needed a clear plan for management. “

Constance Lehman, MD, PhD, Lead Author and Director, Breast Imaging, Associate Director, Avon Comprehensive Breast Assessment Center, Massachusetts General Hospital

The team’s aims were to develop a program that would support patients to continue to engage in immunization programs while ensuring that patients continue to receive their routine health care needs, such as breast cancer screening. . It was also important to inform patients that swollen lymph nodes in the armpit are a normal and expected finding after vaccination.

The organization ‘s approach is based on three principles: 1) promoting the COVID-19 vaccine; 2) reduction and / or delay, cancellation or rescheduling of breast imaging tests; and 3) reduce additional unnecessary imaging and / or biopsies of lymph nodes developed from recent vaccinations.

“In addition to avoiding delays in vaccinations and breast cancer studies, we hope our model will reduce patient anxiety, healthcare provider burden, and the costs of unnecessary assessments of enlarged lymph nodes after vaccinations,” said Lehman.

Lehman and her colleagues – including co-authors Leslie Lamb, MD, MSc, and Helen Anne D’Alessandro, MD – confirm that additional imaging tests are not required for swollen lymph nodes after recent vaccinations if the swelling does not persist or if the patient persists there are other health issues. This message should be communicated to imaging staff and patients.

Patient letters may read: “The lymph nodes in your armpit area that we see on your mammogram are larger on the side where you recently had the COVID-19 vaccine. Enlarged lymph nodes are common after the COVID-19 vaccine and it is normal for your body to respond to the vaccine, however, if you feel a lump in your lump that lasts more than six weeks after your vaccination, you should tell the patient. your healthcare provider. “

Lehman notes that a significant reduction in mammography and breast cancer screening is well documented across several health care centers due to COVID-19 epidemic. “This disorder of breast cancer screening is likely to lead to a significant increase in cancers diagnosed at late stages and increased demand for cancer screening procedures due to delayed reorganization of tests,” she says. We believe our model can reduce or delay vaccinations and further reduce or reduce the diagnosis of breast cancer based on confusion among patients and / or their providers. “