ABSTRACT
Background: Atypical axillary lymph nodes identified on breast cancer screening often result in axillary lymph node core biopsy (ALNB). However, similar changes may occur after vaccination. Recent trends of mass vaccination for SARS-CoV-2 have resulted in new guidelines, specifically delay to biopsy following vaccination to avoid false positives and unnecessary biopsy, with notable exceptions in the context of breast cancer. We aimed to evaluate ALNB pathology, clinical and imaging features in patients who had received SARS-CoV-2 vaccination. Design: We evaluated ALNB specimens from patients who received SARS-CoV-2 vaccine before biopsy (1/2021 - 6/2021) at our enterprise (1 academic and 2 community hospital sites). Clinicopathologic features were assessed by chart and slide review, with pathology review by a dedicated hematopathologist and imaging review by dedicated breast radiologists. Results: Of 135 patients with ALNB, 48 (35.6%) had vaccination prior to biopsy. Patients were predominantly female (47/48;97.9%), with a mean age of 55.1 years (range 19.9-91.3). 34 of 48 (70.8%) were benign, 12 (25%) had metastatic carcinoma, 1 (2.1%) hematologic malignancy (CLL/SLL), and 1 (2.1%) metastatic melanoma. In non-vaccinated patients, the rate of malignancy was similar (24/87;27.6%) (p=0.73). All ALNB with metastatic carcinoma were from patients with concurrent breast carcinoma and the patient with metastatic melanoma had a history of melanoma. Of patients with benign ALNB, 10 (29.4%) had concurrent, 1 (2.9%) recent (within 2 years) and 3 (8.8%) remote (>2 years) history of breast cancer. Most (37/48;77.1%) ALNB specimens could be traced to abnormal breast imaging (Table 1). SARS-CoV-2 vaccine was ipsilateral in 18 (37.5%), contralateral in 14 (29.2%) and side was not documented in 16 (33.3%). Median time from 1st dose to ALNB was 10.6 weeks (range 1.9-23.9) and from 2nd dose to ALNB was 7.7 weeks (range 0-20.9). 16 (33.3%) had a dose within the prior 6 weeks. Benign ALNB in patients who underwent vaccination prior to biopsy comprised: 21 (61.8%) without specific features, 10 (29.4%) reactive follicular hyperplasia, 2 (5.9%) dermatopathic change and 1 (2.9%) tattoo pigment. Reactive follicular hyperplasia was significantly less frequent (4/63;6.3%) in patients who did not undergo vaccination prior to biopsy (p<.01). Conclusions: Some patients who underwent SARS-CoV-2 vaccination with reactive changes may have avoided ALNB if there were more time between imaging, vaccination and breast cancer diagnosis. (Table Presented).
ABSTRACT
BACKGROUND: The COVID-19 pandemic has had an overwhelming impact worldwide. Studies on pediatric populations remain limited, as the burden of disease in pediatric patients appears to be low at this time. OBJECTIVES: To further describe clinical characteristics and severity of disease of confirmed pediatric COVID-19 patients seen and evaluated in a community-based hospital. DESIGN/METHODS: A retrospective chart review of positive COVID-19 patients = 18 years seen in COVID clinic or in the Emergency Department (ED) between April and December 2020 was performed. The results of nasopharyngeal swabs were confirmed using real-time reverse-transcription-polymerase chain reaction (RT-PCR) assays. A descriptive analysis of illness severity, performed via Excel 2019, was based on clinical presentation, laboratory data, and chest X-ray imaging. The categories of illness severity were: asymptomatic, mild, moderate, severe or critical. RESULTS: A total of 53 positive COVID-19 patients were enrolled in this study, which consisted of 24 (45.3%) males and 29 (54.7%) females. The median age was 7.5 years (2.4-12.8). The majority of patients presented with mild symptoms (64.2%), with fever and cough being the main symptoms in 20 (37.7%) and 16 (30.2%) cases, respectively. Other symptoms included sore throat (15.1%), diarrhea (13.2%), headache (9.4%), runny nose (7.5%) and abdominal pain (7.5%). The remaining patients (35.8%) were asymptomatic. Of note, one patient (1.9%) presented with COVID toes requiring referral to a tertiary centre, and one (1.9%) was diagnosed with acute appendicitis. A history of contact with a confirmed COVID-19-positive family member was present in 43 (81.1%) patients, and 6 (11.3%) reported a history of recent travel. Laboratory tests were performed in 7 (13.2%) patients, and chest X-rays were performed in 9 (17%). There were no abnormalities detected in either, other than an elevated CRP seen in one patient with appendicitis. Two (3.8%) patients were admitted, including the patient with appendicitis who developed a perforation and was later transferred to a tertiary care centre to undergo an appendectomy. The majority of patients (96.2%) were discharged home. CONCLUSION: All patients either presented with mild symptoms or were asymptomatic. Fever and cough were the most common presenting symptoms. Due to this, the vast majority of patients were discharged home. The infection in the majority of patients could be traced to a positive family contact. Our findings are consistent with what has been observed previously in our centre as well as worldwide.