Topic: Lymph Nodes on Ultrasound

Forum: Not Diagnosed But Worried — For those who are experiencing symptoms or received concerning test results, but haven't been diagnosed with breast cancer.

Posted on: Nov 15, 2017 01:40PM

Posted on: Nov 15, 2017 01:40PM

djmammo wrote:

Many of you have experienced pain under the arms or felt "swollen" lymph nodes and have had reports that were just short of complete in describing them in my opinion.

The overall size of a lymph node is more often less important than their internal architecture in breast cancer. The key is the thickness of the cortex and the appearance of the fat that lives in the center of the lymph node. When cancer cells enter a node the collect in the cortex making it thick. The increased volume of the cortex enlarges the node and compresses the fat in the center. An abnormal lymph node can be small with a thick cortex and completely effaced fatty center. A normal lymph node can be very large but have a very thin cortex and nice plump fatty center. If the cortical thickness in not included in a report that indicates an enlarged node, I would ask them to revise the report.

The images below are US images and corresponding line drawings of the progression from normal node to abnormal node on ultrasound. (From "the bible" 'Breast Ultrasound' a text book by A. Thomas Stavros, MD, the world's foremost authority on the subject)

Board Certified Diagnostic Radiologist specializing in Breast Imaging. Contact me at DJMammo@gmail.com
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Nov 16, 2017 02:10AM Bmcocean wrote:

Thank you for this!

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Nov 16, 2017 02:58PM MTwoman wrote:

That is SO informative! Thanks DJMammo!

Dx 12/10/2002, DCIS, Right, 1cm, Stage 0, Grade 2, 0/3 nodes, ER-/PR-, HER2- Surgery 12/20/2002 Lumpectomy: Right; Lymph node removal: Sentinel Surgery 12/23/2003 Reconstruction (right): Nipple reconstruction Surgery Reconstruction (right): Saline implant Surgery Reconstruction (right): Tissue expander placement Surgery Mastectomy: Right
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Nov 16, 2017 03:25PM - edited Nov 16, 2017 03:26PM by Irony

This Post was deleted by Irony.
44 y/o IDC/DCIS 5mm Grade 1 ER+/PR+ HER2 -
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Nov 16, 2017 04:36PM marijen wrote:

This is just what I was wondering about. Thank you

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Nov 17, 2017 12:19PM hopeful82014 wrote:

Thank you - that is quite enlightening.

Dx IDC, HER2-
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Nov 28, 2017 09:29AM green71364 wrote:

Thank you! This is very helpful!


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Dec 20, 2017 12:38AM - edited Dec 20, 2017 01:39AM by RoamingNomad

Thank you so much for this amazing resource.

I am 30 years old and I too have "mystery" pain, tenderness, and inflammation in my L axillary lymph nodes. It's like a painful thin mishapen sponge-web that's not hard but also definitely not normal under my skin. The pain and sick feeling seems to start during my ovulation but it hurts all month long to some degree and has been for about a year and a half. The sick feeling I get from it (I'm developing a hunch like a wounded animal over this "thing") coupled with serous/bloody, unilateral, single-duct nipple discharge that began >6 months ago, coupled with finding a mass in my right breast caused me to finally wake up from what I can only describe as a mental block or willful ignorance brought on by my own Mother being dx with Inflammatory BC when I was 19. I was her sole patient-advocate and caregiver from age 19-25 and she ultimately passed away with Mets to bone and blood. She was 46 at dx and passed away at 51.

I got a referral for an ultrasound from Planned Parenthood. At the US today a person who I think was a radiologist came in for 5 mins at the end and said in the right breast it looked like a cyst. Luckily I spent time memorizing what the expected indicators would be for various results and I was relieved to come to the same conclusion during the ultrasound with the technician. Cyst had been my guess from palpation beforehand and was the least of my worries. He also said they found several cysts in the left breast. When I specifically asked "But how did my lymph nodes look?" He said "I did not see any masses".

When I asked about the bloody nipple discharge, which was the primary reason on my referral for my being there, he said if it continued to "bother me" I should see a surgeon. He was rude and dismissive and literally kept one hand on the doorknob during the conversation.

I was really overwhelmed mentally/socially at this point so I just said okay and he left. The technician and I think someone she was training stayed behind and technician told me her Mom died from BC in her 40s and she strongly recommended that I keep pursuing this but did not mention what tests or what type of doctor I should go to for more information.


I do know in my heart and in my mind from studying medical journals and case studies that what I am presenting with does exactly match the criteria for being suspicious. It's spontaneous, persistent, it's orange-ish clear-ish (like you think of lymph if you skinned your knee) somewhat sticky when it comes out and on my bra it's blood stained in dots. I sometimes get a tiny fleck of dried blood but not a scab per say. And now in the spot on my nipple that it comes out of it looks kind of shiny and it's a slightly different color than anywhere else.

So according to this diagnostic his opinion was if it bothers me see a surgeon or just do nothing.

I don't know what to do..

Is it common for DCIS to present with lymphadenopathy?

The practitioner at Planned Parenthood is who they will send my results to but she already told me she could only order them and cannot interpret them. I plan to get a copy of my diagnostic results and look to see for myself what my lymph nodes look like. I feel like I will at least be able to differentiate whether they appear simply inflamed/reactive to something systemic or idk what. When I reviewed the graphic you posted here after returning home I felt D most matched what my lymph nodes appeared to me during the quick and stressful US but that one says metastatic or severe inflammation so still no clear indicator one way or another there.

And now several hours later the whole area is sore and tender. I can feel it and it hurts just from my arm being down.

I was hoping to leave this appointment with a more clear picture and action plan or possible relief but I feel more worried than ever.

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Dec 20, 2017 08:24AM djmammo wrote:

RoamingNomad

Bloody nipple discharge is never normal. Sometimes US will show an intraductal mass but not always. A ductogram will show the inside of the duct more clearly. Cyclical pain in the axilla is often due to ectopic breast tissue located there. It will cycle with the rest of the breast tissue. PM me the US report here when you get it. Look for the measurement of the cortical thickness. If they don't mention it, ask that an addendum to the report be issued.

Board Certified Diagnostic Radiologist specializing in Breast Imaging. Contact me at DJMammo@gmail.com
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Jan 18, 2018 09:44PM RoamingNomad wrote:

After all that they did not even take still shots of my lymph nodes during the sono or mention them in the report whatsoever and when I asked about it I was told I would need another referral.. It took me quite a while to get in to see my primary doctor and in the month that has passed my lymph nodes changed from tender to painless but hard and rubbery. I just now had another ultrasound today which I will very gladly send over the results as soon as I receive them. I have lost over 20% of my body weight in the past 6 months and I very much get the impression my doctor thinks the problem is "anxiety" which I do not have. Thank you for being so respectful and kind and sharing your knowledge.

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Mar 6, 2018 01:53AM marijen wrote:

RoamingNomad never came back, I guess she’s ok. I had three nodes US’d today and they said they were normal. But I saw white specks in two of them? And little red arrows. Came here to check the pics. They don’t feel normal. The fishbowl waiting room was full up too. The tech said she could recognize them by their appearnce. Really dj?


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