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Topic: consistent with an intramammary lymph node finding

Forum: Benign Breast Conditions —

A safe place to worry for members who have not been diagnosed with breast cancer, but have concerns about their breasts.

Posted on: Sep 26, 2020 08:40AM

Aniseday wrote:

I’m back. A year ago I was flagged for calcification in left breast. 6 mo ago I was told they were stable and if they remain stable I could go back to annual screenings. Yesterday after 1 yr mammo and US the tech (yes - the tech) came and told me I was stable and come back in 6 mo. I was confused but didn’t have access to radiologist for clarification. The test results were just released. Now I understand. Calcification remains stable but I now have a “solid oval mass consistent with an intramammary lymph node“ that is probably benign. Dr. Google tells me these appear in less than 5% of imaging and it indicates poor outcomes overall and most likely indicates regional metastatic spread. Seriously? I don’t understand. My annual exam is in 2 weeks so what should I be asking her? What needs to be seen before a biopsy is warranted?

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Sep 26, 2020 09:41AM Beesie wrote:

Ah, this is why Dr. Google is dangerous. You are mixing up your googling and drawing a completely incorrect conclusion.

The presence of intramammary lymph nodes on mammogram and ultrasound imaging is not an problem. They are a normal part of our anatomy.

The concern comes when an intramammary lymph node is found to be cancerous. This is usually found in conjunction with a breast cancer diagnosis or, on preliminary imaging, a suspicious lesion.

When a Radiologist sees an intramammary lymph node on imaging, an assessment is made based on the appearance of the node, with the Radiologist looking for very specific factors that identify the node as being a normal node that is benign. If these factors are not all there, then a biopsy will be ordered. But if the node meets all the criteria for being benign, a BIRADs 3 may be assigned just to be extra cautious.

Intramammary lymph nodes

"There are two critical issues in evaluating intramammary lymph nodes on mammograms:

  1. the nodes are - without exception - smoothly circumscribed and well defined. If the lesion is not very neatly and clearly outlined or loses this feature on follow up studies, it is not a simple node.
  2. the nodes are low density lesions. If they are projected over the profile of the muscle, you will see the muscle through the node. If this feature disappears or the "node" increases in density on follow up you are not dealing with a simple lymph node. To judge the density of a node, look for one in the tail of the breast on the MLO view - they should have similar densities.

If these two criteria are kept in mind, these lesions will rarely cause confusion or misdiagnosis."


Lymph Node: Non-Cancerous Breast Masses

"Seeing a lymph node on a patient's first mammogram may prompt additional imaging to ensure that the mass is in fact a normal lymph node. Additionally, any changes in previously seen normal lymph nodes will also prompt additional imaging evaluation. However if there is no known personal history of cancer, the vast majority of lymph nodes encountered in the breast are benign. Once I can establish a normal baseline appearance for intramammary and axillary lymph nodes through imaging or possibly biopsy, I can be confident on future mammograms that the mass represents a benign lymph node as long as no imaging changes have occurred."

“No power so effectually robs the mind of all its powers of acting and reasoning as fear.” Edmund Burke
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Sep 26, 2020 10:17AM Aniseday wrote:

*sigh* The dangers of Dr. Google and an overly anxious mind. I’m thankful I remembered this forum and knew I would find help to explain this finding further to me and why a biopsy was not recommended. Last time reassurance about my “probably benign” calcification finding saved undue distress. It remains stable. All is well there. So I will stay the course and followup in 6 months and expect the best. I so appreciate what you’ve shared...and so quickly. Fear can become such a time waster..

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Sep 26, 2020 10:36AM Beesie wrote:

Glad to have helped!

Hopefully you have no worries before then and we'll 'see' you in 6 months when you have your successful / stable follow-up!

“No power so effectually robs the mind of all its powers of acting and reasoning as fear.” Edmund Burke
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Oct 6, 2020 08:33AM PurpleCat wrote:

Heh. I logged on to ask about this very thing, and this is the very first post that caught my eye. I just read the results of my MRI, which reported no evidence of malignancy and some benign changes attributable to surgery and radiation. Huge relief. But then I had to go and read the whole report, and found a "stable intramammary node" in the non-cancer breast. From reading the responses above, it sounds like this is something that showed up on the MRI I had 2 years ago during diagnosis, just wasn't specifically noted in that report, and hasn't change since then so is not a problem?

Dx 10/2018, IDC, <1cm, Stage IA, Grade 2, 0/3 nodes, ER+/PR+, HER2- Surgery 10/4/2018 Lumpectomy Surgery 10/18/2018 Lymph node removal: Sentinel Surgery Prophylactic ovary removal Hormonal Therapy Femara (letrozole) Radiation Therapy Hormonal Therapy Tamoxifen pills (Nolvadex, Apo-Tamox, Tamofen, Tamone)
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Oct 6, 2020 08:53AM MelissaDallas wrote:

Not a problem. You have lymph nodes all over your body. When they are visualized on breast imaging they are noted-this is a normal finding.The fact that they are there doesn’t mean that there is anything whatsoever wrong with them.

LCIS, extensive sclerosing adenosis, TAH/BSO & partial omentectomy for mucinous borderline ovarian tumor.

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