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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Oct 25, 2019 07:45PM alegna_natuj wrote:

Hi djmammo!

My lymph node US result has reniform shape with preserved fatty hilum but eccentric cortical thickness meausring 0.6cm , and second one has reniform shape with preserved fatty hilum uniformly thickness cortex measuring 0.6cm . what does this mean? Im so scared to death , fear of unknown :( . God bless whoever can decipher thi

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Oct 25, 2019 09:00PM djmammo wrote:

Alegna_Natuj

Se answer to your PM.

Board Certified Diagnostic Radiologist specializing in Breast Imaging. Contact me at DJMammo@gmail.com
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Feb 8, 2020 08:00AM Zenkris wrote:

if a lymph node has doubled in size to 3.5 cm over the past year and a half, but no other issues on the mammogram, would that be indicative of cancer? I have a biopsy on Monday, and I am on the verge of a panic attack with the worry.

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Feb 8, 2020 08:18AM djmammo wrote:

Zenkris

The overall size can be misleading. The important measurement is that of the cortex of the node and the appearance of the central fat in the center of the node. These are best demonstrated on US.

You can have a 4cm node with a 2mm cortex and large amount of fat centrally and be benign. Alternatively you can have a 1cm node with a cortex so thick it compresses the central fat to a mere sliver and be malignant.

Important to note is that nodes can enlarge for many reasons that are completely unrelated to the breast and breast cancer. Also it would be unusual to have a node measuring 3.5cm due to the spread of a breast cancer without the primary tumor having already made its presence known.

Board Certified Diagnostic Radiologist specializing in Breast Imaging. Contact me at DJMammo@gmail.com
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Feb 8, 2020 08:32AM Zenkris wrote:

thank you for the reply. I'm concerned that it has grown over the past year. Everything I'm reading says this is indicative of some sort of cancer.

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Feb 8, 2020 10:28AM - edited Feb 8, 2020 11:44AM by djmammo

Zenkris

My response reflects everything that I have read.

Post the report with the exact measurements taken of the node including the thickness of the cortex and the appearence of the fatty center, how many enlarged nodes were seen on that side and how many were seen on the other side. Are there any in your neck or groin? Have you had recent abnormal blood work?

Let us know what the biopsy shows.

Click here for more info: https://www.verywellhealth.com/axillary-lymph-nodes-2252131

Board Certified Diagnostic Radiologist specializing in Breast Imaging. Contact me at DJMammo@gmail.com
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Feb 8, 2020 12:19PM Zenkris wrote:

the report I got is that they are calling it probably benign. It previously measured 2.6x1x1.1. Now it is 3.6x1.1x1.9. They state that it likely represents a lymph node. A surgical consult is recommended (I'm going Monday). I wasnt given any other details. They are closed today and nothing is showing in my online chart. I guess I just have to wait it out and pray for the best.

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Feb 9, 2020 09:15PM lulu44 wrote:

Hi everybody. Is it possible to have cancer in the lymph nodes even if they feel normal on palpation and appear normal on ultrasound? Mine appeared normal on u/s and were reportedly normal on palpation but following neoadjuvant chemo I had a positive node and 4 others that felt abnormal but were clear. I’m wondering if all5 were affected and 4 tested clear due to the chemo. Any insight on this? thanks

Dx 6/28/2019, IDC, Left, 2cm, Stage IIA, Grade 3, 1/5 nodes, ER+/PR+, HER2- Targeted Therapy 7/16/2019 Herceptin (trastuzumab) Chemotherapy 7/16/2019 Carboplatin (Paraplatin), Taxotere (docetaxel) Targeted Therapy 7/16/2019 Perjeta (pertuzumab) Surgery 12/16/2019 Lumpectomy; Lumpectomy (Left); Lymph node removal Targeted Therapy 1/1/2020 Kadcyla (T-DM1, ado-trastuzumab) Surgery 1/21/2020 Radiation Therapy 1/27/2020 Whole breast: Breast, Lymph nodes Hormonal Therapy 3/6/2020 Arimidex (anastrozole), Aromasin (exemestane)
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Feb 9, 2020 11:05PM minustwo wrote:

djmammo has provided a wonderful batch of information in the header. I'm bumping so new comers will be able to read his explanation when they are worried.

Yes, I had cancer in a lymph node that felt normal & did not show up anywhere - until it did.

2/15/11 BMX-DCIS 2SNB clear-TEs; 9/15/11-410gummies; 3/20/13 recurrance-5.5cm,mets to lymphs, Stage IIIB IDC ER/PRneg,HER2+; TCH/Perjeta/Neulasta x6; ALND 9/24/13 1/18 nodes 4.5cm; AC chemo 10/30/13 x3; herceptin again; Rads Feb2014
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Feb 10, 2020 10:14AM Zenkris wrote:

They are not going to do a biopsy. She says it has clearly defined borders and looks normal. I'm to go back in 3 months to get it checked, and if it has grown, I will get a biopsy then.

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