Lymph Nodes on Ultrasound
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There is no abnormal description in your report if thats what your question is.
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Thank you djmammo for this wonderful information ! Once again, you and the others who post information on this forum educate me as I take another step in this journey and I am so thankful for your efforts.
I had quite the surprise at my 9 month post op ONC appointment. I mentioned to her that about a month ago I experienced a sore underarm lymph node on my cancer side. The soreness resolved after a couple of days. I mentioned to my oncological massage therapist and she felt I had overused the arm and possibly had some lymphatic congestion. My Oncologist yesterday, however immediately checked the area and found two nodes she felt were swollen. So wednesday I have my first axillary ultrasound. But I think if I have to choose between lymphedema and C, well lets take option #1.
And after doing some research that SNLB is about 90 - 94% effective, I do wonder why ultrasound imaging prior to surgery is not a standard step? I know the likelihood is smallish to miss the path the cancer takes but it seems logical to me to add this option. It would be interesting to hear your opinion. I would think that if my swollen nodes are positive, that we missed this somehow as I am not that far out from surgery.
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In my practice when a malignancy was identified in the breast on US, we always examined the nodes in that axilla and report their appearance. The sentinel node is determined by the injection of a tagged material that is taken up by the lymphatics. The sentinel node is removed along with any that we indicated looked abnormal on US.
A node can contain cancer cells and appear normal on US. Since US is an 'anatomic' exam (based on size and shape) the node does not appear abnormal until a threshold number of cancer cells have entered the node to thicken its cortex and compress its fatty hilum. I don't know what that number is but thats what microscopy is for. This renders US unreliable to exclude spread to the nodes if the node looks normal. You can biopsy the node at US but if there are not enough cancer cells present, and you miss them on bx you get a false negative. We can assume the lowest node we see on US is the sentinel node but again this is unreliable.
The sentinel node exam using the radiotracer, is a 'physiologic' study assessing function not appearance. It tells us the first node that the cancer would enter, the path the cancer would take on its way out of the breast, and is our best shot at determining if 'the horse got out of the barn' no matter what it looks like on US. Not sure how many other nodes are taken if they all 'look' normal on US. A certain percentage of pt's will get arm swelling with an axillary node dissection that is purely mechanical, unrelated to the presence of tumor. Not sure if that would cause otherwise normal nodes to enlarge due to lymphatic obstruction but I suppose thats possible.
Do they want to remove those nodes or bx under US?
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I am not sure. I am only scheduled for the US, then will have a follow up consult with the BS if imaging indicates further investigation is needed, which I assume would then be some type of biopsy.
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All nodes imaged were classified normal based on US imaging. So no further testing, but I am to report any changes. Thanks for your input djmammo.
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you can also just have a reactive/swollen node. That's what I have. It had to be biopsied and caused a great deal of stress. So it's not just lymphedema vs. cancer...
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Absolutely correct Blah333. Glad to hear your lymph node was clear of C.
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Hi dmammo,
I had posted a new thread about my lymph node a day or so ago then I saw this explanation above! Thank you for taking the time to share the info and diagrams above! Very informative and helpful! I'm going to check my last ultrasound report. To see what it said last time I had it ultrasounded. I have another breast ultrasound in May. This time I'm doing automated ultrasound. The lymph node I have that isn't 'going down' in size is on my right side on edge of right breast by my ribs like I think at 7 or 8 o'clock. It's weird. Does not seem to be any smaller since last ultrasound. But still big enough to definitely feel it. I can see it when I lift my arm up.
I’m probably just being paranoid!
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Thank you djmammo. The fatty hilum was normal last time. I go in again in May and I am sure they probably will continue to keep an eye on it. It is a little creepy tho....to feel it. lol. Thank you for letting me know.
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i had a mammogram march 22 and it noted a change in lymph nodes on both breast from past mammograms and was sent for an ultrasound March 28 on my lymph nodes. Dr called Friday that I need a biopsy on a few nodes only on April 18 .I am scared and confused .
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sorry at work how do I get the results ?
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thanks
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It will take 24 hrs to set up my chart on line .Thanks for all you do .
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Thanks for the information in this thread. I had my regular mammogram this week and was called back for a diagnostic mammo w/contrast and an ultrasound. I called my oncologist because of course I did (!) to find out what is up. I am almost exactly five years out from my original diagnosis and treatment, this finding is on my opposite side in the remaining breast. My oncologist said the report noted swelling of my axillary node and he was not concerned. He said the follow up was appropriate. He also said looking at the results that "you would have to prove to me that was cancer, I don't look at this and think 'prove to me it's not'" At any rate, how would one go about having a cancerous node without presentation of cancer in the breast? My understanding is elementary but I thought the flow was breast->nodes>elsewhere if it gets past the nodes.
I hate this scanxiety but I am VERY appreciative of this site.
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It’s possible to have cancer in a lymph node. It’s called Primary Occult Breast Cancer. It means they can’t “find” the primary tumor. Why would your doctor expect you to prove anything, that’s his job. Can you get a copy of your report?
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Oh, thank you marijen. I was having trouble finding information and it's good to have a name to search. My oncologist wasn't asking me to prove it, I didn't write that very well. His comment to me got lost in the translation of writing it down - he was saying when he looks at an image that sometimes he can immediately tell by the characteristics ie: prove to me that's not cancer. With my image he didn't feel that way at all and will look for my diagnostic tests on May 7. He was reassuring me that he didn't have any concerns. We have a long history with my breast cancer treatments and colon cancer in 2016 and I got what he meant even if I couldn't articulate here
I am very grateful for your response!
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You’re welcome bow, I’m glad he is a nice doc. I only had one node positive. It takes a biopsy to know for sure but they can tell a lot from the US. Good luck. Oh and do you know how big the node is?
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marijen = I don't have the report yet and it's not yet posted on MyChart. It was Friday afternoon when I got the request for follow-up, it should get posted this weekend or early next week. I find this highly annoying about online records, they can see at the office but it's not immediately accessible to the patient until it's "released" by a health professional. Suppose that helps to only release after the team talks to the patient but UGH. I'm just going to put on my best chill face and meditate my way to Monday when I can get my hands on it.
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When you get your results you can post them here for Djmammo. Lymph nodes swell for other reasons. You can search Why Lymph Nodes Swell. I hope everything turns up negative. Try to enjoy the weekend!
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Following are the results from my mammogram, I will be having contrast mammogram and an ultrasound in two weeks. Will post those results as well, the more information we can share the better I think. Thanks!
MAMMOGRAM: Interpretation is performed utilizing computer-aided detection. Standard digital Right CC and MLO views were obtained. There are scattered areas of fibroglandular density.
No suspicious mass, suspicious calcifications or unexpected architectural distortion. Question mildly prominent right axillary lymph nodes.0 -
Bow, I hope the next tests are more definitive.
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marijen, me too. I will be asking the questions about mammogram distortion considering the concern seems to be the size of the node and not the structure. This was the least "ow you're killing me" mammogram I've ever had haha. Really though, I wonder. Also wonder about lymphocytic leukemia, which my father had...ugh. At any rate, I am at peace with this report and feeling pretty chill about the follow-up tests. It's been enough scanxiety situations for me in the last 5 years that I've learned to experience the chill. Surgery was 5 years ago today, I just realized! Woohoo!
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The description of the nodes is vague. Mildly prominent is a poor description. It doesnt say which feature is prominent.
The upcoming US should evaluate the overall size of the node, the thickness of the cortex and a description of the central fat within the node in order to be complete.
And yes in cases of breast cancer the mass in the breast is usually detected before the lymph nodes are visibly affected.
As far as leukemia is concerned, have you had a CBC in the recent past? It would be more common to have nodes enlarged on both sides not just one, if that were the case.
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Thanks for responding, djmammo. I have CBC every 6 months, last one in January and expected again in July. I have had an L mastectomy with lymph node removal therefore no mammogram on that side. My counts are normal high (WBC in particular) with no spikes or areas of concern and no symptoms of systematic disease. I am high risk with self, mom, grandma BC and I'm hoping that is the catalyst (less than a huge red flag, more of a cautionary approach) for having another look. We shall see
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I had my one year followup to my surgery. Nothing on the Mammo but the MRI showed a slightly enlarge (less than 1 cm) axillary lymph node. So, they did an ultrasound biopsy.
Results were: Negative for malignant cells; lymphocytes present; sparsely cellular specimen. Satisfactory for evaluation.
I thought great! No cancer recurrence! But, they also want me to have a PET scan on Friday because there can be a "false negative". Sigh. I had about 45 minutes of being out-of-fear, and now right back to anxiety. I hope they are just covering all bases, but am not sure. Anyone had this? Thanks.
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Wow I have one lymph node that is over 2cm and they say that's a normal size! I've had it US'd 4 times plus two MRI's but they won't do a biopsy.
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PalBuddy I hope your PET went well. It's such a dichotomy, being happy that we are watched closely but dealing with the stress of scans. Thinking of you.
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