[Skip to Content]
[Skip to Content Landing]

Axillary Lymphadenopathy After COVID-19 Vaccination in a Woman With Breast Cancer

Educational Objective
Based on this clinical scenario and the accompanying image, understand how to arrive at a correct diagnosis.
1 Credit CME

A 39-year-old healthy woman without family history of malignancy found a mass in her right breast at 38 weeks of pregnancy. Prior to delivery, she underwent diagnostic ultrasound of the right breast, which showed a possible mass in the location of the palpable lesion that was most consistent with a normal island of fibroglandular tissue. Follow-up mammogram and ultrasound of the right breast (without axillary evaluation) were performed 6 months later, which showed an irregular 17-mm mass with associated pleomorphic calcifications in the same area. Ultrasound-guided biopsy was performed. Pathology showed high-grade, estrogen receptor–positive ductal carcinoma in situ (DCIS). On postbiopsy physical examination, the patient had a palpable 2.5-cm right breast mass at the 3-o’clock position without palpable axillary lymphadenopathy.

Please finish quiz first before checking answer.

You answered correctly!

Read the answer below and download your certificate.

You answered incorrectly.

Read the discussion below and retake the quiz.

A 39-year-old healthy woman without family history of malignancy found a mass in her right breast at 38 weeks of pregnancy. Prior to delivery, she underwent diagnostic ultrasound of the right breast, which showed a possible mass in the location of the palpable lesion that was most consistent with a normal island of fibroglandular tissue. Follow-up mammogram and ultrasound of the right breast (without axillary evaluation) were performed 6 months later, which showed an irregular 17-mm mass with associated pleomorphic calcifications in the same area. Ultrasound-guided biopsy was performed. Pathology showed high-grade, estrogen receptor–positive ductal carcinoma in situ (DCIS). On postbiopsy physical examination, the patient had a palpable 2.5-cm right breast mass at the 3-o’clock position without palpable axillary lymphadenopathy.

Survey Complete!

Sign in to take quiz and track your certificates

Buy This Activity

JN Learning™ is the home for CME and MOC from the JAMA Network. Search by specialty or US state and earn AMA PRA Category 1 Credit(s)™ from articles, audio, Clinical Challenges and more. Learn more about CME/MOC

CME Disclosure Statement: Unless noted, all individuals in control of content reported no relevant financial relationships. If applicable, all relevant financial relationships have been mitigated.

Article Information

Corresponding Author: Diana L. Lam, MD, Department of Radiology, University of Washington, Seattle Cancer Care Alliance, 1144 Eastlake Ave E, LG2-216, Seattle, WA 98109 (dllam@uw.edu).

Published Online: December 23, 2021. doi:10.1001/jama.2021.20010

Conflict of Interest Disclosures: None reported.

Additional Contributions: We thank the patient for providing permission to share her information.

References
1.
Mehta  N , Sales  RM , Babagbemi  K ,  et al.  Unilateral axillary adenopathy in the setting of COVID-19 vaccine.   Clin Imaging. 2021;75:12-15. doi:10.1016/j.clinimag.2021.01.016PubMedGoogle ScholarCrossref
2.
Edmonds  CE , Zuckerman  SP , Conant  EF .  Management of unilateral axillary lymphadenopathy detected on breast MRI in the era of COVID-19 vaccination.   AJR Am J Roentgenol. 2021;217(4):831-834. doi:10.2214/AJR.21.25604PubMedGoogle ScholarCrossref
3.
Özütemiz  C , Krystosek  LA , Church  AL ,  et al.  Lymphadenopathy in COVID-19 vaccine recipients: diagnostic dilemma in oncologic patients.   Radiology. 2021;300(1):E296-E300. doi:10.1148/radiol.2021210275PubMedGoogle ScholarCrossref
4.
Washington  T , Bryan  R , Clemow  C .  Adenopathy following COVID-19 vaccination.   Radiology. 2021;299(3):E280-E281. doi:10.1148/radiol.2021210236PubMedGoogle ScholarCrossref
5.
Bettini  E , Locci  M .  SARS-CoV-2 mRNA vaccines: immunological mechanism and beyond.   Vaccines (Basel). 2021;9(2):147. doi:10.3390/vaccines9020147PubMedGoogle ScholarCrossref
6.
Lederer  K , Castaño  D , Gómez Atria  D ,  et al.  SARS-CoV-2 mRNA vaccines foster potent antigen-specific germinal center responses associated with neutralizing antibody generation.   Immunity. 2020;53(6):1281-1295. doi:10.1016/j.immuni.2020.11.009PubMedGoogle ScholarCrossref
7.
Moderna COVID-19 Vaccine: Vaccines and Related Biological Products Advisory Committee Meeting, December 17, 2020. Accessed September 28, 2021. https://www.fda.gov/media/144434/download
8.
Polack  FP , Thomas  SJ , Kitchin  N ,  et al; C4591001 Clinical Trial Group.  Safety and efficacy of the BNT162b2 mRNA Covid-19 vaccine.   N Engl J Med. 2020;383(27):2603-2615. doi:10.1056/NEJMoa2034577PubMedGoogle ScholarCrossref
9.
Adin  ME , Isufi  E , Kulon  M , Pucar  D .  Association of COVID-19 mRNA vaccine with ipsilateral axillary lymph node reactivity on imaging.   JAMA Oncol. 2021;7(8):1241-1242. doi:10.1001/jamaoncol.2021.1794PubMedGoogle ScholarCrossref
10.
Becker  AS , Perez-Johnston  R , Chikarmane  SA ,  et al.  Multidisciplinary recommendations regarding post-vaccine adenopathy and radiologic imaging: Radiology scientific expert panel.   Radiology. 2021;300(2):E323-E327. doi:10.1148/radiol.2021210436PubMedGoogle ScholarCrossref
AMA CME Accreditation Information

Credit Designation Statement: The American Medical Association designates this Journal-based CME activity activity for a maximum of 1.00  AMA PRA Category 1 Credit(s)™. Physicians should claim only the credit commensurate with the extent of their participation in the activity.

Successful completion of this CME activity, which includes participation in the evaluation component, enables the participant to earn up to:

  • 1.00 Medical Knowledge MOC points in the American Board of Internal Medicine's (ABIM) Maintenance of Certification (MOC) program;;
  • 1.00 Self-Assessment points in the American Board of Otolaryngology – Head and Neck Surgery’s (ABOHNS) Continuing Certification program;
  • 1.00 MOC points in the American Board of Pediatrics’ (ABP) Maintenance of Certification (MOC) program;
  • 1.00 Lifelong Learning points in the American Board of Pathology’s (ABPath) Continuing Certification program; and
  • 1.00 credit toward the CME of the American Board of Surgery’s Continuous Certification program

It is the CME activity provider's responsibility to submit participant completion information to ACCME for the purpose of granting MOC credit.

Close
Want full access to the AMA Ed Hub?
After you sign up for AMA Membership, make sure you sign in or create a Physician account with the AMA in order to access all learning activities on the AMA Ed Hub
Buy this activity
Close
Want full access to the AMA Ed Hub?
After you sign up for AMA Membership, make sure you sign in or create a Physician account with the AMA in order to access all learning activities on the AMA Ed Hub
Buy this activity
Close
With a personal account, you can:
  • Access free activities and track your credits
  • Personalize content alerts
  • Customize your interests
  • Fully personalize your learning experience
Education Center Collection Sign In Modal Right
Close

Name Your Search

Save Search
With a personal account, you can:
  • Access free activities and track your credits
  • Personalize content alerts
  • Customize your interests
  • Fully personalize your learning experience
Close
Close

Lookup An Activity

or

My Saved Searches

You currently have no searches saved.

Close

My Saved Courses

You currently have no courses saved.

Close