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Lymph Nodes on Ultrasound

245

Comments

  • jsacks
    jsacks Member Posts: 3
    edited October 2018

    Djmammo, thank you so much for taking the time to review this report.. It means everything to me. You are making such a difference here on this forum for people. My results are as followed:

    Technique: digital mammo diagnostic bilateral was performed. Targeting bilateral US was also performed.

    Comparison: this is a baseline exam.

    Findings: the breasts are heterogeneously dense, which may obscure small masses.

    LEFT Mammo diagnostic bilateral: there is subcentimeter asymmetry seen in the lower central region of the left breast. No suspicious calcifications.

    LEFT Breast US: US was performed for further evaluation of the imaging and reported clinical findings. Between 2:00 and 4:00, in the region of the reported palpable abnormality several cysts are seen with the largest measuring 8mm. At 5:30 3cm from the areolar margin there is a 5x7x10mm microlobulated hypoechoic mass which is clearly not seen on mammo images. In the area of the mammo asymmetry at 6:00 posteriorly there is no suspicious sonographic finding.

    RIGHT mammo diagnostic bilateral. No suspicious mass, suspicious calcifications or other abnormality.

    RIGHT US breast limited: targeted US of the breast was performed for further evaluation of the palpable mass identified on clinical breast exam. At 9:00 4-5 cm from nipple there is normal tissue planes without cyst or solid mass. However, at 9:30 9cm from the areolar margin there is a 3x5x7 mm lymph node with a thickened vascular cortex.

    Impression: LEFT breast assessment suspicious biopsy recommended. 1. Indererminate hypoechoic mass at 5:00 identified on US should have US guided core biopsy recommended. 2. Mammographic asymmetry in the lower central breast which does not appear to correspond to the sonographic finding. No definet sonographic correlate os identified. If biopsy is benign follow up in 6mo is recommended. If biopsy malignant enhanced mri recommended.

    RIGHT breast assessment: suspicious. Biopsy recommended. 1. Abnormal lymph node in the far lateral breast at 9:00. US guided FNA recommended. 2. No descrete sonographic finding in the reported area of palpable abnormality detected on clinical breast exam.

    Well, there it is.. So gyn felt a lump on both breasts thats why i had the mammo and US. I cant feel anything because it feels like ribs under the tissue of both breasts. I am a nurse on a critical care floor so i care for patients who have had breast reconstruction with free flap and im scared. My grandmother died from unknown breast cancer and a few members of my family had BC as well.

    Im worried about that enlarged lymph node on my right breast. Im not sick i havent been sick so that has me worried. But i dont know alot about cancer. I see the repair of cancer not the before and after. So can cancer from one breast spread to a lymph node on the other? The mass in left breast described microlobulated hypoechoic isnt reassuring especially when searching the web.

    Any thoughts would be helpful. Biopsy and fna is scheduled 10/23. As of now gyn says its going to be fine.. I know this report doesnt feel fine. Id rather know whats happening?

    Thanks again for everything...


  • djmammo
    djmammo Member Posts: 1,003
    edited October 2018

    jsacks

    Im worried about that enlarged lymph node on my right breast. Im not sick i haven't been sick so that has me worried.

    They call it an abnormal node but without supporting evidence. The overall dimensions are not abnormal. They mention a thickened cortex but give no measurement which is the key feature. Normal lymph nodes are vascular and if you turn the Doppler settings up a bit they can look really vascular. No mention is made of the appearance of the fatty hilum so it might not be a lymph node at all. If a node is enlarged from something systemic, the axillary nodes would also be big as well as others elsewhere.

    So can cancer from one breast spread to a lymph node in the other?

    No.

    The mass in left breast described microlobulated hypoechoic isnt reassuring especially when searching the web.

    Firstly, dont search the web. Second, they dont say its cystic or solid and there is no mention or shadowing or through transmission so it could go either way, lobulated solid mass vs cluster of benign cysts and third dont search the web. And if you must search the web stick to reputable research sites such as ncbi.nlm.nih.gov. I would guess many of the authors of breast cancer related articles in popular publications dont really understand what they are writing but parroting information from source articles.

    Let us know what the biopsies show.

  • jsacks
    jsacks Member Posts: 3
    edited October 2018

    Djmammo,

    Thank you very much... I know its still wait and see but at least now i know what is happening and that means so much. I have to wait until 10/23 for biopsy and fna. I even scheduled an appointment in November with a breast surgeon just in case. Appointments through Penn medicine are always a month or more out so i wanted to be ahead of the game just in case. I already got out my hard cry and now i can sleep... So thank you again for this.. I will add you and everyone here in my prayers..




  • SmallTownGal
    SmallTownGal Member Posts: 7
    edited October 2018

    Thank you for this information, djmammo! It does help.


  • SmallTownGal
    SmallTownGal Member Posts: 7
    edited October 2018

    I had an ultrasound today for an enlarged (2 cm) left axillary lymph node seen on 3D mammo. The mammo was otherwise unremarkable. The ultrasound tech said the node looked normal, just large. She even went in and checked with the radiologist to make sure she was imaging the correct area. I felt relieved until I came home and started Googling axillary lymph nodes and cancer. Now I am freaking out. I do currently have a sinus infection and also had a flu shot in the left arm just six days prior to the mammogram. I just wonder if I celebrated a little too early.

  • djmammo
    djmammo Member Posts: 1,003
    edited October 2018

    SmallTownGal

    The overall size is less of a concern than the thickness of the cortex. Does the report mention the thickness of the cortex? And yes the flu shot could cause a change in the nodes in the same-side axilla. I had a Rubella vaccine in 2009 in order to join the staff of a particular hospital and a few weeks later all my cervical nodes where big and tender, I had trouble moving my neck without pain. Turns out its a know side effect of that vax.

  • SmallTownGal
    SmallTownGal Member Posts: 7
    edited October 2018

    No report as yet. I keep checking my online chart (where results are posted) but nothing yet. Also, no phone call from anybody as yet. I am going totally on the tech's assessment of the node as looking normal. But, I won't feel comfortable until I see a formal report. The longer I wait, the more I worry.

    Does a long wait time mean an abnormal result? I keep picturing phone calls between the radiologist and my doctor, trying to figure out how to proceed. How long should it take to generate an ultrasound report? I've gotten normal digital mammography reports within 24 hours before--same facility.

  • SmallTownGal
    SmallTownGal Member Posts: 7
    edited October 2018

    Got the ultrasound report on the hospital system's online chart last night after 10 pm. It says benign 2 cm node recommend 1 year screening mammography. Yay! I only have access to the narrative portion of the report.

  • green71364
    green71364 Member Posts: 9
    edited January 2019

    Is it common for enlarged axillary nodes, that have 4 ultra sound tests on them, all recorded as fatty hilum and thin cortex, to remain forever? Its been two years.

  • djmammo
    djmammo Member Posts: 1,003
    edited January 2019

    green71364

    The overall size of a lymph node (length x width) is not that critical. It can be 2+cm and still be normal if there is a nice plump fatty hilum and a nice thin cortex especially if they have always been that size and they are not changing over time.


  • green71364
    green71364 Member Posts: 9
    edited January 2019

    Thank you so much! You really are amazing!

  • bbjkas
    bbjkas Member Posts: 2
    edited February 2019

    I had an ultrasound and mamo recently due to a painful lump in my left breast. The dr said everything looks normal but I did notice some large lymph nodes on the ultrasound and based on the picture here I'm not sure if it's normal. I know it's not my place to look at that but I've had this painful lump for months now and I do feel like something is off in my breast so I don't feel comfortable with the dr's opinion that there's just nothing to see there.

    Would you be willing to take a look at my lymph nodes ultrasound? And how can I send them to you?

  • bbjkas
    bbjkas Member Posts: 2
    edited February 2019

    @djmammo

    I had an ultrasound and mamo recently due to a painful lump in my left breast. The dr said everything looks normal but I did notice some large lymph nodes on the ultrasound and based on the picture here I'm not sure if it's normal. I know it's not my place to look at that but I've had this painful lump for months now and I do feel like something is off in my breast so I don't feel comfortable with the dr's opinion that there's just nothing to see there.

    Would you be willing to take a look at my lymph nodes ultrasound? And how can I send them to you?

  • djmammo
    djmammo Member Posts: 1,003
    edited February 2019

    bbjkas

    PM me the report if you can cut and paste or scan it in .

  • kitkit
    kitkit Member Posts: 29
    edited February 2019

    Hello all,

    I am back after seven years without incident after my lumpectomy of left breast that showed early LCIS. No radiation. For the last few years I have had pain in area of surgery near left armpit. I have been followed up consistently with 6 month mammo and 6 month MRI. Every time I mention that I have continuing pain in area of lumpectomy it is attributed to scar tissue and/or nerve damage. A few weeks ago, as a result of MRI, mammo, and ultrasound, I've been told I have two suspicious axillary lymph nodes (2 cm) and one normal one in the same area. They have not shown up before. The concerning description of these nodes is that they are round and with no fat inside. I do not have symptoms of being ill; no weight loss, lots of energy etc. On Monday I go to have a needle biopsy using ultrasound. As I wait for the results I am, of course, researching the boards. My question: does anyone here have benign results from lymph nodes with no fat inside them? My hope, of course, is that I have had continuing infection that has never gone away from lumpectomy in the area. Am I being reasonable?

    Thanks everyone

  • djmammo
    djmammo Member Posts: 1,003
    edited February 2019

    kitkit

    In general if a particular node was normal in appearance on prior studies and now the central fatty hilum is completely effaced, one would worry about metastatic disease to the lymph nodes.

    If all you had was LCIS this seems unlikely as LCIS is not cancer and does not metastizize. "Despite the fact that its name includes the term "carcinoma," LCIS is not a true breast cancer. Rather, LCIS is an indication that a person is at higher-than-average risk for getting breast cancer at some point in the future. For this reason, some experts prefer the term "lobular neoplasia" instead of "lobular carcinoma." A neoplasia is a collection of abnormal cells."

    The other scenario is metastatic disease to a lymph node from an occult cancer in that breast. Usually the primary in the breast declares itself before a lymph node is visibly changed but not always.

    If this finding you are describing is completely new, and does not correspond to a lymph node in that exact location on prior studies it may be a new primary, which would contain no fat.

    As a rule infection enlarges the node but does not obliterate the central fat as you have described.

  • kitkit
    kitkit Member Posts: 29
    edited February 2019

    Thank you djmammo! I was hoping that you would reply!

    I do understand that LCIS was not cancer.

    "it may be a new primary, which would contain no fat." What does this mean?

    My understanding is that the lymph nodes did not show up in prior studies because they were outside the area that was imaged. So, not sure of their prior condition.

    Can you give me some positive possibilities I can dwell upon before I get needle biopsy this Monday? What benign condition(s) could cause these non-fatty lymph nodes?

    Thanks so much,


  • djmammo
    djmammo Member Posts: 1,003
    edited February 2019

    kitkit

    The key is to know if it were previously a normal lymph node but in this case I guess there is no way to know that. The hallmark of a normal lymph node is a plump fatty hilum with a thin cortex. Without the fat its either an abnormal lymph node or not a lymph node at all.

    I have in the past seen small invasive ductal cancers arise near enough to the axillary lymph nodes to be mistaken for an abnormal lymph node. I have never seen a fibroadenoma near those nodes though I guess thats a possibility.

    Let us know what the bx shows.

  • kitkit
    kitkit Member Posts: 29
    edited February 2019

    Thank you. I will advise next week.

  • jp18
    jp18 Member Posts: 12
    edited February 2019

    I'm curious if you all have ever heard of a 4 mm hypoechoic complicated cyst increasing to 5 mm with a 'feeding vessel' which was not present when first diagnosed in 6 months. Now think it is a solid lymph node but needs nothing to be done. What growth constitutes biopsy? Is having a 'feeding vessel' which is new normal?

  • melissadallas
    melissadallas Member Posts: 929
    edited February 2019

    What exactly does your report say? Try posting it on the Interpreting Your Report thread

  • jp18
    jp18 Member Posts: 12
    edited February 2019

    August 1, 2018

    BI-RADS 0; Density Category B; needs diagnostic mammogram and ultra sound due to asymmetric density in upper outer quadrant of right; lesion noted

    August 8, 2018

    Persistent 4 mm nodule upper outer quadrant; corresponds to mammogram findings

    4 mm hypoechoic nodule or cyst with internal septation/internal debris 10 o'clock; outer quadrant right breast

    BI-RADS III

    Feb. 2019

    hypoechoic lymph node - 5 mm with feeding vessel - no change from previous (?- this looks like change to me); return in one year.

  • blah333
    blah333 Member Posts: 68
    edited February 2019

    DJmammo could you please have a look at this other post of mine:
    https://community.breastcancer.org/forum/105/topic...


    I am awaiting biopsy results (I had to have it done twice) for swollen nodes. One has been swollen since the first US after my surgery (3 months post op when I had a bout of swelling). They were concerned that the swelling of the node never went down. In Dec they claimed that the appearance changed though the tech that took the images brought up my last three and said that she had just provided more points of view at the most recent US which they bumped me from BIRADS 3 to 4a. At my biopsies the hilum IS present, though faintly, and the radiologist said that it normally appears to be white and more evident. The first FNA they fucked up and got skeletal muscle. They had gone for the deeper node that had been swollen this whole time, though now there is a 2nd swollen node. The original node that was of most concern appeared to be smaller at my biopsy-redo while the more newly swollen node appears larger on the screen (I watched the whole thing, I always look at the US screen). Although they failed to get a sample of the first swollen node, they were able to get a clip right in the center of it.

    From my reports:


    Surgery 12/2017
    3/01/2018: There is an axillary lymph node in the left breast. The cortex measures 4mm
    10/31/2018: There is a stable left axillary lymph node. The cortex measures 5mm
    12/28/2018: Targeted ultrasound of the left axilla demonstrates a lymph node measuring 12 x 5 x 4 mm. The cortex is thickened to 5 mm and the fatty hilum is not visualized.


    To me this seems stable? Logically I would assume it is a reactive node. But I have had on and off mild lymphedema since August and about 3 weeks after that first bout of it, my ribs now sort of jut out, which I think is chondrosis but haven't been able to talk to doctors about it yet. Let me know what you think. I may have to wait as long as 2/25 for my results.




  • djmammo
    djmammo Member Posts: 1,003
    edited February 2019

    blah333

    That is a lot of information. For me it would be helpful if you could condense these posts down to a few direct questions.

  • blah333
    blah333 Member Posts: 68
    edited February 2019

    I was just wondering if you think it's likely on this info that my swollen nodes will be reactive or it is malignancy. I know it's a small probability due to DCIS but still. They made it seem like my node is changing but the cortex seemed pretty stable according to their numbers that I listed above.

    Why do nodes stay reactive? Can lymphedema/chondrosis make nodes more prone to stay swollen?

    I wish there was something I could do to "help" my nodes. I don't want to have to get FNAs every year or two. I know they said after two years if a swollen lymph node is still benign they just call it reactive/monitor it.....

  • djmammo
    djmammo Member Posts: 1,003
    edited February 2019

    blah333


    I was just wondering if you think it's likely on this info that my swollen nodes will be reactive or it is malignancy.

    *** No way for me to know

    I know it's a small probability due to DCIS but still. They made it seem like my node is changing but the cortex seemed pretty stable according to their numbers that I listed above.

    *** See this article: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC43892...


    Why do nodes stay reactive? Can lymphedema/chondrosis make nodes more prone to stay swollen?

    ***Are you asking why do/don't reactive nodes stay enlarged? Blockage of the lymph channels causes lymphedema. Also surgical removal of lymph nodes can cause this as the channels are interrupted. Not sure how chondrosis is related to this topic.

    I wish there was something I could do to "help" my nodes.

    ***There are forms or physical therapy for lymphedema of a limb, I am not aware of anything for the nodes themselves.

    I don't want to have to get FNAs every year or two. I know they said after two years if a swollen lymph node is still benign they just call it reactive/monitor it.....

    ***As a rule of thumb, anything we see in the breast (that we already feel is benign) that is completely unchanged after two years we do not follow agressively.

  • blah333
    blah333 Member Posts: 68
    edited February 2019

    Thank you. I just mentioned chondrosis because I know it is an inflammation and with me is linked to swelling/my mild lymphedema. I didn't know if general strain in the surgery site can cause stress on the lymphatic system.... my brain is just wandering as I await results. I didn't expect to need biopsies so soon after DCIS + mastectomy.

  • georgie1112
    georgie1112 Member Posts: 104
    edited March 2019

    A lung cat scan showed an 8mm lymph node on the side of my ILC breast cancer (2006). A followup ultrasound was performed. My history of breast cancer was not noted in the report which has been in the other imaging reports when ordered by the oncologist. This was ordered by my nurse practitioner as my oncologist retired. Does it matter that my history of breast cancer isn't in the report? I am worried about "abnormal" finding and difficulty of imaging lobular cancer. Any thoughts on followup as none is recommended? I would think my history of breast cancer would change the recommendation for followup which was none?

    US Report

    "Narrative US Extremity Limited

    Clinical Data: Right axillary lump

    Technical Data: Grayscale and color Doppler ultrasound of the right axilla was performed.

    Comparison: No prior studies available". (They are at another hospital in another city).

    "Findings: The palpable abnormality corresponds to a right axillary lymph node. This measures 1.0 x 0.6 x 1.0 cm and contains a fatty hilium. This is unchanged when compared to prior CT examination." (CT was 13 months ago).

    "Impression: Right axillary lymph node. No suspicious features".

  • djmammo
    djmammo Member Posts: 1,003
    edited March 2019

    georgie1112

    It is always best to make your old studies available to each facility doing your imaging. As I have said before "One old film is better than two old radiologists". It is most important however when there is an abnormal finding to see if its better, stable or worse.

    In this case they describe a normal lymph node and although not an US, they do have a comparison from over a year ago that shows no change.

    For completeness sake, and for the sake of the record I would let them know your history and get your old studies for them to have on file for the future.

  • georgie1112
    georgie1112 Member Posts: 104
    edited March 2019

    I told them where my old studies were but they did not retrieve or ask for them. What does the "abnormal" description mean? The hospital patient advocate is asking them to get my old studies. I am worried bc lobular cancer can be hard to find until it is larger so I hope they will recommend a biopsy.