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 02:40PM

Posted on: Nov 15, 2017 02:40PM

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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May 7, 2019 05:03PM bow1965 wrote:

Quick update - I got more information during my ultrasound. The radiologist explained that the node in question was larger in comparison to my mammogram 1 year ago. She noted in ultrasound that it is enlarged and showed me the area. I would put it in the "a" diagram range - the white is still defined but the dark portion is larger than normal. I do not have reference for how enlarged it is but it is not palpable. They also did an ultrasound on my breast which still appears clear. Next up is punch biopsy on Thursday. Ugh, those hurt.

I have looked at my test results over the last 2 years and there may be some clues there which would not have stood out on there own but I will wait until the results of the biopsy due 3 days after the procedure and let you know. Also, the radiologist is the same who told me I most likely had breast cancer during round one so what the heck, bring on the flashbacks!

Thanks for being here, all. It really matters.


Dx 3/2014, IDC, 3cm, Stage IIIA, Grade 2, 4/9 nodes, ER+/PR+, HER2- Surgery 4/24/2014 Lymph node removal; Lymph node removal (Left); Mastectomy; Mastectomy (Left) Chemotherapy 5/20/2014 AC + T (Taxol) Radiation Therapy 9/15/2014
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May 14, 2019 06:04PM bow1965 wrote:

Verbal description (from my oncologist's nurse) of my path report for biopsy of my axillary node:

Tissue:

No evidence of malignancy

follicular lymphoid hyperplasia

Flow sytometry:

No evidence of lymphoma

No evidence of monoclonality

So, I'm good for now. I hope this information helps someone else! And whew, the stress valve really releases when you hear results and I, as now, had no idea how much pressure it was causing. Hang tough, all. Thank you for this thread, it was invaluable to have this space I trust to read other's expertise and experiences.


Dx 3/2014, IDC, 3cm, Stage IIIA, Grade 2, 4/9 nodes, ER+/PR+, HER2- Surgery 4/24/2014 Lymph node removal; Lymph node removal (Left); Mastectomy; Mastectomy (Left) Chemotherapy 5/20/2014 AC + T (Taxol) Radiation Therapy 9/15/2014
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May 16, 2019 08:26PM - edited May 31, 2019 08:01AM by jp18

The chart posted above is very helpful - thank you djmammo. It is an appreciated resource when learning about what may possibly be growing. My 'mass' was first discovered in August 2018, had call back for dx mammogram and ultrasound. Went back in for 6 month check up. Have had a few look at images. It has been very confusing in that my mass has been classified as: possible node, complicated cyst, complex cyst, lymph node, not a cyst - solid - not sure, and possible intramammary lymph node. All agree that it is hypoechoic, has since become palpable (was not when first discovered), and seems to have established a 'feeding tail' - not previously seen. No one seems to be able to verify what it actually is - other than 'it is most likely benign' and wait a year for a recheck. There is something about no one being able to state what it most likely is with consistency and waiting a year that just makes me nervous. Some of my images look similar to the chart, but I am definitely no expert. Most that I talk with are shocked that no one thinks a biopsy is warranted.

I am curious if anyone else has had a lymph node issue. Did it seem to come out of 'no where'? Did anyone experience this 'vague' type of identifying what the growth is? Was it a lymph node or did it end up being something else? I know we have lymph nodes that swell and can get irritated/inflamed, but this intramammary term is new to me and I want to avoid heading to Google for information.

Any thoughts and/or insights would be greatly appreciated.

** Edit **

I am not sure if I am posting in the wrong areas, using language that does not gather feedback, or what. I just do not seem to get much if any feedback when I post. I did want to update and say that I am having a biopsy next week with a breast specialist. I'm sure all will be fine. It will be good to hopefully have an answer either way.

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May 16, 2019 10:34PM marijen wrote:

I’ve had a lymph node under my armpit on the good side for four years. It aches, I’ve had ultrasounds and another breast MRI and they say it’s normal but it feels like a marble to me. I just want it out. I’m so tired of worrying about it. They won’t do a biopsy. Is there anyone I can see just to have it removed?

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May 17, 2019 11:09AM djmammo wrote:

marijen

I'm sure a surgeon would remove that if you asked but ins may not pay for it as they will likely classify it as "not medically necessary" or even cosmetic, coming under the heading of 'elective' surgery so you may have to pay the entire billing.

Board Certified Diagnostic Radiologist specializing in Breast Imaging. Contact me at DJMammo@gmail.com
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May 17, 2019 12:04PM marijen wrote:

Thank you Djmammo, I hadn't thought about that. Do you think that insurance may not pay for a biopsy if I push for it?


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May 17, 2019 01:27PM Sam183 wrote:

I’m Sorry DJmammo, it only allows me to send a certain number of private messages a day. To answer your private message: I went to the er bc I had pain and swelling. Pain and swelling is gone now. Yes you can feel the mass, it’s directly under my nipple. 2 days after my mammogram, I raised my arms and noticed an indention (dimple) on the same breast. But not even close to where my mass is. It’s towards the inside of my breast down close to the bottom. Also I had 2 separate occasions towards the end of last year where that same nipple discharged blood (without squeezing) no mass felt then. If my doctor thought it was a papilloma Why would she suspected it to be malignant? And why would there be increased vascularity? And give me a bi-RADS score of 4/5 from my ultrasound? Mammogram Bi-RADS 0 if i read the report correctly.

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May 17, 2019 05:35PM djmammo wrote:

marijen

The ins company goes by the radiology report's recommendation. If the radiologist gives it a benign reading someone would have to call and advocate for you if you wanted a biopsy. Perhaps your PCP or ObGyn can order it on the basis of clinical findings and get it paid for that way.

Board Certified Diagnostic Radiologist specializing in Breast Imaging. Contact me at DJMammo@gmail.com
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May 17, 2019 05:57PM marijen wrote:

Thanks Djmammo, I will see what they say next time I’m in for an appointment

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May 26, 2019 03:35PM eigna wrote:

Hello,

I'm new here. I don't know much yet. I went for a routine mammogram and was called back two days later to do an ultrasound. I went for my ultrasound and the report says that they are seeing a intrammamary nodule hypoechoic,with irregular margins and probably a fatty hilum. I will be contacted from the hospital for further assessment and maybe a biopsy but they are not sure yet. I don't understand. How can I have a malignant nodule if they cannot see any tumor. Worried sick. My doctor says I have nothing to worry about. Anybody else have thiskinda of results? Please reply.

Diagnosed at 43. Weakly ER+ Dx 8/20/2019, Left, 1cm, Stage IB, Grade 3, 0/2 nodes, ER+/PR-, HER2- Surgery 10/10/2019 Lumpectomy; Lumpectomy (Left) Chemotherapy 12/17/2019 Cytoxan (cyclophosphamide), Taxotere (docetaxel) Radiation Therapy 3/31/2020 Whole breast: Breast

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