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
Log in to post a reply

Page 2 of 13 (124 results)

Log in to post a reply

Mar 6, 2018 03:54AM djmammo wrote:

marijen

Recognizing things by their appearance is kinda the basis of the entire specialty of radiology so yes, really. ;-)

The white in the middle of a lymph node is fat. The “red arrows” were probably the node’s arterial supply being demonstrated with Doppler.

Do you have the final report you can post

Board Certified Diagnostic Radiologist specializing in Breast Imaging. Contact me at DJMammo@gmail.com
Log in to post a reply

Mar 6, 2018 04:16AM marijen wrote:

Thanks DJ. No report yet but I will get one. The Dr. rdaiologist did not look at the pics in the exam room, so I’m assuming they are networked to his office? Not sure about what you mean -I saw the doppler as the tech worked, but the saved pics were gray, two with a the white speck and the red arrows. She reduced the size to 80% when sheleft the room. It was hard to read.

Log in to post a reply

Mar 6, 2018 04:44AM djmammo wrote:

marijen

Yes the rad sees the study on PACS. Some can watch the exam in real time.

The study didn't look normal to you on the screen?

Board Certified Diagnostic Radiologist specializing in Breast Imaging. Contact me at DJMammo@gmail.com
Log in to post a reply

Mar 6, 2018 05:01AM marijen wrote:

Well I’m not a tech but it looked normal except when she turned on the doppler, then I didn’t know what to think. They don’t want to say if it’s normal or not. The biggest one was 2.2 cm. The same size as my positive node removedon the other side. One was .7 x 1.something cm. I’ll send the report when I get it. Why are you up so late? I can’t sleep.

Log in to post a reply

Mar 6, 2018 01:32PM - edited Mar 8, 2018 04:00PM by marijen

Djmammo, the nurse called this morning and posted my reports. There is nothing to question. Mammo is benign and US is benign. They did give the size of the nodes as per my request. And it says no suspicious calcifications, masses, or architectural distortions and no abnormal appearing lymph nodes, masses, or fluid collections were seen. Thanks so much for your help and for starting this topic! It's time to stop worrying, oh what will I do : )

Oh oh I missed something, it also says continue clinical monitoring of left breast. DJ, does that mean they still aren’t 100% sure the nodes are normal? I think so...

Log in to post a reply

Jun 13, 2018 11:57PM 3Cubs wrote:

Oh the things we think when we have nothing to do but wait and think. I had a CT scan in April that discovered "several prominent and borderline enlarged right axillary lymph nodes measuring up to 12 mm in short axis diameter". Nothing else was noted. This led my breast specialist to call me in for a screening mammogram and ultrasound, as I have had issues with the right axillary and breast for years, and also have the ATM mutation. However, all my US report said was benign lymph nodes, with no other information at all. But, the mammogram found "an asymmetry in the right breast posterior depth outer region
seen on the craniocaudal view only"...There is no sonographic abnormality seen in the right breast to
correspond with the mammographic density.
A follow-up right mammogram in 6 months is recommended to demonstrate
stability. BIRADS 3

It is being explained as possible residual bruising to my breast from a car accident that occurred February 12. I am not so sure I want to wait 6 months to see if that is the case. I am almost 39. Both my grandmothers had BC in early 40s. Two of my father's sisters were diagnosed with BC TWICE...one in early 40s, and then again in 70s. The other in early and late 60s...and lost to mets to bone and blood. I have 3 young kids. How do I proceed and at least get the peace of mind I need that I will be healthy for my children for years to come?!

Log in to post a reply

Jun 14, 2018 05:01AM djmammo wrote:

3Cubs

US is more accurate at assessing individual lymph nodes than CT. It can show the internal architecture which is more reliable than size in calling a node abnormal. 12mm is not large for a lymph node though for some reason they reported the "short axis" rather than the "long axis" of the node, odd.

US is also very good for assessing asymmetric tissue density. If there is nothing seen on US, a short-term follow up is pretty standard. Did you have compression views of that area on the day you had the US? MRI would be the next step but if the US is completely negative there may not be anything big enough to easily biopsy.

Board Certified Diagnostic Radiologist specializing in Breast Imaging. Contact me at DJMammo@gmail.com
Log in to post a reply

Jun 14, 2018 08:21AM 3Cubs wrote:

Thank you for your reply. I did have several mammogram views the same day, though I can't speak to whether that is considered compression views. I am waiting for a response from my breast specialist..she had suggested doing a repeat u/s in 3 months if that would reassure me, instead of waiting 6 months for the diagnostic mammogram. I am scheduled for the diagnostic in early November, and my regularly scheduled MRI in January, as I am on a 6 month mammo/MRI rotation due to my genetic risk factors. I am just concerned about the wait-factor. I feel like waiting 6 months to check stability is too long when you consider the possibilities. We are going on a hunch that is just residual bruising...after 4 months...and if it isn't, then I have lost 6 months.

Also, I should note that my breast specialist did inform me that they had noted the lymph nodes on my previous MRI and mammo but that they were not the sizes noted on the CT, I guess. She literally said, "We had noted lymph nodes." but didn't go into detail about WHAT they noted. I am not sure why the CT reported one axis vs. another...it was in a different hospital system that I am not to happy with for other reasons right now. Specifically, they told me my CT was normal but I am literally waiting to see the cardiologist right now because it in fact was NOT normal. Just too much going on at once.

Log in to post a reply

Jun 14, 2018 09:53AM Frenchiegal83 wrote:

This is so amazing! Thank you for posting this! My MRI 6 months ago and the one completed in May discussed "probable intramammary lymph nodes" in November and then suddenly in the same positions that these nodes were seen were the areas they wanted to biopsy. I asked the radiologist what causes the changes if they were lymph nodes to something different and he basically told me lots of different things so I didn't get a warm fuzzy about his answer but this def helps! I watched during my core needle biopsies and the most strange looking area looked like a mix between g & f. Still thinking it'll be benign but there's nothing I can do to change the course, so whatever happens will happen. Really appreciate this info and thread, thank you!

Log in to post a reply

Jun 14, 2018 02:32PM sbelizabeth wrote:

djmammo--thank you so much for your generous input here. You're providing information that's reassuring and enlightening.

I thought I would mention a fact about lymph nodes I learned from my own experience. My initial presentation was a 3-inch "umbrella" of pink, peau d'orange skin--dermal lymphatic invasion, we now know--over a 0.8 cm lump. No palpable lymph nodes. Everyone concentrated on the small lump--not the skin--and when a lumpectomy with sentinel node biopsy was done, the nodes were so chock-full of tumor that there was no uptake of either the radioactive tracer or the blue dye. Fortunately my surgeon manually explored the axilla until she found a hard node, and when that was biopsied and proven malignant, completed the axillary dissection.

Since then I've learned that with dermal lymphatic invasion, lymph node uptake during sentinel node hunts is very unreliable. My axilla was never imaged with ultrasound, probably since we all got tunnel vision on that 0.8 cm lump, but if we had looked, I bet the nodes would have been small but abnormal.

pinkribbonandwheels.wordpress.... Dx 10/20/2011, IDC/IBC, Left, 1cm, Stage IIIB, Grade 2, 6/28 nodes, ER+/PR+, HER2- Chemotherapy 12/15/2011 Adriamycin (doxorubicin), Cytoxan (cyclophosphamide), Taxotere (docetaxel) Surgery 4/18/2012 Mastectomy; Mastectomy (Left) Radiation Therapy 5/21/2012 Breast, Lymph nodes Hormonal Therapy 7/19/2012 Femara (letrozole) Surgery 4/15/2013 Reconstruction (Left): DIEP flap; Reconstruction (Right): DIEP flap

Page 2 of 13 (124 results)

Scroll to top button