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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Feb 10, 2020 10:41AM djmammo wrote:

Zenkris

Both benign and malignant lymph nodes have well defined borders.

Let us know what the follow up study shows.

Board Certified Diagnostic Radiologist specializing in Breast Imaging. Contact me at DJMammo@gmail.com
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Feb 18, 2020 03:34PM - edited Feb 18, 2020 06:05PM by Zenkris

This Post was deleted by Zenkris.
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Feb 18, 2020 03:41PM djmammo wrote:

Zenkris

Please do not post diagnostic images.

Board Certified Diagnostic Radiologist specializing in Breast Imaging. Contact me at DJMammo@gmail.com
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May 18, 2020 11:01PM - edited May 18, 2020 11:33PM by MelCam78

Almost a year ago I began experiencing pain in my left breast. There was also a strange indented line forming when I lifted it with a small lump. I went in for a mammogram and received a letter a few weeks later saying that they wanted to do more imaging. I went back for another mammogram and was told it was just a lymph node. After the pain continued, I was eventually seen for an ultrasound and was told again it was just a lymph node.

Fast forward to today, and after experiencing continued pain coupled with a significant amount of weight loss, I was referred for another mammogram and ultrasound. This time around, they told me they didn't see anything. Not even the aforementioned lymph node.

I got the impression they felt I should be relieved, but in fact I'm feeling quite the opposite. A lymph node doesn't just disappear, does it? Shouldn't it have been relatively easy to find based on previous imaging? Shouldn't they have made sure to find it so they could compare it against previous imaging? I'm feeling very much like they didn't do what they were supposed to and I'm not really sure what to do about that.

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May 20, 2020 11:51AM djmammo wrote:

MelCam78

Do you have the reports or did the tech say they didn't see the lymph node?

Board Certified Diagnostic Radiologist specializing in Breast Imaging. Contact me at DJMammo@gmail.com
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May 20, 2020 12:43PM berries wrote:

The problem I had with a lymph node ultrasound, during my breast exam, was that nothing was shown. I had the US and MRI and everything looked to be clear.

A month later, 4 nodes were positive, one being 8mm. Terrifying that imaging cannot always detect these things as it may have changed my treatment plan.I likely would have had chemo before surgery to better understand how my lesion would have responded to chemo ...now I just don't know.

Dx 8/6/2019, DCIS/IDC, Left, 5cm, Stage IB, Grade 1, 4/4 nodes, ER+/PR+, HER2- Surgery 9/18/2019 Mastectomy; Mastectomy (Left); Reconstruction (Right) Chemotherapy 10/24/2019 AC + T (Taxol) Surgery 2/17/2020 Reconstruction (Left): Silicone implant Radiation Therapy 3/31/2020 Whole breast: Breast, Lymph nodes Chemotherapy 4/29/2020 Xeloda (capecitabine) Hormonal Therapy 5/7/2020 Arimidex (anastrozole)
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May 20, 2020 05:28PM djmammo wrote:

berries

Can you post the MRI report?

Board Certified Diagnostic Radiologist specializing in Breast Imaging. Contact me at DJMammo@gmail.com
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May 20, 2020 05:44PM - edited May 20, 2020 05:45PM by berries

Hi DJMammo - sure! It is below. Post-surgery, my lesion was 5.5cm and a second was 1.7cm. 4/4 nodes were positive, but again, the lymph nodes were a big surprise.

Your insight is appreciated!

FINDINGS:
The breasts have extremely fibroglandular tissue. The background
parenchymal enhancement is mild.

LEFT BREAST: There is a vitamin E marker overlying the upper outer
posterior left breast. There is focal susceptibility in the upper outer
posterior left breast from a biopsy clip. There is an 8.6 x 5.3 x 4.8 cm
area of regional non-mass enhancement in the upper outer left breast,
which extends posteriorly to the chest wall and corresponds to the site of
biopsy-proven malignancy. The anterior extent of non-mass enhancement is
located on series 9/image 87 and series 20/image 55. There are mixed
kinetics with areas of rapid initial and washout delayed phase
enhancement. There is an indeterminate 1.3 x 0.6 x 1.4 cm oval
circumscribed enhancing mass in the central posterior left breast 9.3 cm
posterior to the nipple with rapid initial and persistent delayed phase
enhancement (series 9/image 111, series 20/image 54). There is an
indeterminate 0.6 x 0.4 x 0.5 cm area of clumped non-mass enhancement in
the central posterior left breast 7.4 cm posterior to the nipple with
rapid initial and persistent delayed phase enhancement, which is located
approximately the 1.0 cm anterior to the 1.3 cm mass (series 9/image 114,
series 20/image 57). Additional scattered foci of enhancement in the left
breast are favored to represent background parenchymal enhancement.
The left axilla is within normal limits.

Dx 8/6/2019, DCIS/IDC, Left, 5cm, Stage IB, Grade 1, 4/4 nodes, ER+/PR+, HER2- Surgery 9/18/2019 Mastectomy; Mastectomy (Left); Reconstruction (Right) Chemotherapy 10/24/2019 AC + T (Taxol) Surgery 2/17/2020 Reconstruction (Left): Silicone implant Radiation Therapy 3/31/2020 Whole breast: Breast, Lymph nodes Chemotherapy 4/29/2020 Xeloda (capecitabine) Hormonal Therapy 5/7/2020 Arimidex (anastrozole)
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May 20, 2020 06:31PM - edited May 20, 2020 06:34PM by MelCam78

I wasn't given the reports, the tech just came back into the room after consulting the radiologist and said they didn't see anything and I could go. The breast specialist I'd seen previously later gave me a call and said they didn't see anything, not even the lymph node. I asked her if that meant it was smaller or just not visible because it confused me, and she said it was just not visible and that they don't always show up. Are the reports something I can request? I didn't realize. I have Kaiser and have found it's very difficult to get information. Thank you for your response.

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May 20, 2020 06:33PM berries wrote:

Hi Mel,

If you are signed up on your patient portal (MyChart or Epic or another tool), they should be posted for you there. You can also contact the records dept. to request any report you need. Hope this helps.

Dx 8/6/2019, DCIS/IDC, Left, 5cm, Stage IB, Grade 1, 4/4 nodes, ER+/PR+, HER2- Surgery 9/18/2019 Mastectomy; Mastectomy (Left); Reconstruction (Right) Chemotherapy 10/24/2019 AC + T (Taxol) Surgery 2/17/2020 Reconstruction (Left): Silicone implant Radiation Therapy 3/31/2020 Whole breast: Breast, Lymph nodes Chemotherapy 4/29/2020 Xeloda (capecitabine) Hormonal Therapy 5/7/2020 Arimidex (anastrozole)

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