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Axillary Lymph Node Core Biopsy Following SARS-CoV-2 Vaccination
Modern Pathology ; 35(SUPPL 2):938-939, 2022.
Article in English | EMBASE | ID: covidwho-1857118
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).
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Collection: Databases of international organizations Database: EMBASE Topics: Vaccines Language: English Journal: Modern Pathology Year: 2022 Document Type: Article

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Collection: Databases of international organizations Database: EMBASE Topics: Vaccines Language: English Journal: Modern Pathology Year: 2022 Document Type: Article