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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Jun 29, 2018 09:43AM kwilli wrote:

DJMammo; I was just dx with IDC; the report stated "Targeted ultrasound of the right axilla demonstrates a borderline lymph node with a cortex measuring up to 3mm in thickness. Several other benign appearing lymph nodes with thin cortices are present".

I'm wondering if I should be concerned about "borderline" and request that it be further investigated? It's a bit unnerving, to be honest....

Kim.

Dx 7/2018, IDC, Right, 6cm+, Grade 3, ER-/PR-, HER2- Chemotherapy 8/13/2018 AC + T (Taxol) Surgery 1/8/2019 Lymph node removal; Mastectomy; Mastectomy (Right); Prophylactic mastectomy; Prophylactic mastectomy (Left) Chemotherapy 3/28/2019 Xeloda (capecitabine)
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Jun 29, 2018 10:02AM djmammo wrote:

The cortical thickness is the important measurement and it’s normal. They should monitor the overall size periodically if they are concerned to make sure it is stable.

Board Certified Diagnostic Radiologist specializing in Breast Imaging. Contact me at DJMammo@gmail.com
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Jun 29, 2018 10:04AM kwilli wrote:

thank you!!

Dx 7/2018, IDC, Right, 6cm+, Grade 3, ER-/PR-, HER2- Chemotherapy 8/13/2018 AC + T (Taxol) Surgery 1/8/2019 Lymph node removal; Mastectomy; Mastectomy (Right); Prophylactic mastectomy; Prophylactic mastectomy (Left) Chemotherapy 3/28/2019 Xeloda (capecitabine)
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Jul 10, 2018 12:47AM french14 wrote:

Hi, I noticed you mentioned that you have the ATM gene mutation. I have it also. Did you know we shouldn't be having CT's or x-rays, only MRI's? I just want to save you from any other problems.

Dx 8/26/2014, DCIS/ILC/IDC, Right, 2cm, Stage IIB, Grade 2, 2/14 nodes, ER+/PR-, HER2-, Surgery 10/1/2014 Lymph node removal: Right, Sentinel, Underarm/Axillary; Mastectomy: Left, Right; Reconstruction (left): Nipple reconstruction, Nipple tattoo, Silicone implant, Tissue expander placement; Reconstruction (right): Nipple reconstruction, Nipple tattoo, Silicone implant, Tissue expander placement Surgery 10/2/2014 Lumpectomy: Right; Lymph node removal: Right, Underarm/Axillary Chemotherapy 11/4/2014 AC Chemotherapy 1/27/2015 Taxol (paclitaxel)
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Aug 18, 2018 09:48PM 3Cubs wrote:

I am on a schedule of MRIs alternating with mammograms so that I have some imaging every 6 months, although I did not know about not having CTs or xrays. Should I tell my primary care physician, then, as well as other medical professionals I encounter? I had a CT due to car accident, then because of chest pain and risk of blood clots... Most recently, I had a mammogram to follow up on my area of asymmetry. It was unchanged and they decided it was bi-rads 4 and did stereotactic biopsy taking 6 samples 3 weeks ago...all benign! I followed directions and felt better after a few days but lately I am experiencing considerable pain in my breast and a lot of aching in the axilla. I had thought maybe I had an infection brewing 2 weeks ago from it as I was extremely run down but no fever, heat, redness or swelling. Just pain.

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Sep 19, 2018 04:23PM karw41 wrote:

Hello, I had mammograms for two years with enlarged lymph nodes and the radiologist did not refer me to get them looked at more closely. A new (female) radiologist did the review of the mammogram this year and immediately referred me to ultrasound. I got it done and she said the cortices and fat etc looked normal and marked it as such on her ultrasound report, but she orally told me that I should follow up on the enlarged lymph nodes since while they looked normal in structure, they were enlarged/larger and had been for three years now. I was floored the last radiologist did not mention the lymph nodes AT ALL or refer me for an ultrasound for TWO YEARS. Now, my question is: I went to the primary doctor for CBC/blood work since there must be some reason they are enlarged. She said get a second opinion from an actual breast care center. I had to go through the former primary care doctor where the breast care center is, and that doctor totally poo-poo'ed my even wanting to go to the breast care center since the ultrasound for breast cancer purposes said "normal" in structure. She acted cold and annoyed that I was asking to be seen when the report said normal in structure but enlarged. I at least want to establish care at a specialty care center again since my mother had breast cancer three times, two different cancers and one recurrence, and got a double mastectomy. I am negative for BRCA genes they tested me for, but have a lot of family cancer. My question is: is it reasonable to bring these findings and take myself to an appointment to at least get into the system for next time with an actual breast care center?? If I get my records there, I will feel better since this last place did not even note the findings to me, but just sent me that page they have to by law stating all was benign, follow up in a year, for two years despite the actual written report stating that the axillary lymph nodes were enlarged in 2016 and 2017. Also, is it reasonable to get a second opinion despite there not being abnormally structured lymph nodes?? Thank you for any assistance. I'm pretty mad I had that for two years and no one even ultrasounded me until the third year, even if they look normal in structure on further screening. They could not tell that from the diagnostic mammograms they did.

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Sep 19, 2018 04:25PM karw41 wrote:

I'm just another patient out here but if I were having pain, I would make an appointment and talk with someone. My mother had various issues and did not go to the doctor and it caused her more problems later on, for postponing going to the doctor.... That's just my own personal two cents, to be more on the cautious side than not, from what I saw my mother experience.

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Sep 20, 2018 07:15AM djmammo wrote:

KARW41

Again the overall size of the node, length x width, is less relevant than the width of the cortex + appearance of the central fat. They can be several centimeters in length and still be ok if the cortex is normal. If they measure large on both sides it is less worrisome for a breast abnormality than if they are "enlarged" unilaterally. The number of nodes that can be seen on mammo varies from patient to patient. If they can be seen on 2-4 past mammograms one should be able to tell if they are getting larger. Cortical thickness is best seen and measured on US as is the condition of the central fat. Do you have a report with these measurements?

The significance of truly abnormal lymph nodes varies with concomitant findings. If there are abnormal nodes only on one side, and there is a breast abnormality on that side, one can suspect breast cancer. If the big nodes are on both sides and there is no breast abnormality then the problem may be systemic like lymphoma. If the big nodes are unilateral and there is no breast abnormality then perhaps there is an infection in that upper extremity and so on.

Board Certified Diagnostic Radiologist specializing in Breast Imaging. Contact me at DJMammo@gmail.com
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Oct 7, 2018 02:51AM jsacks wrote:

hello,

I recently had an abnormal mammo and ultrasound a few days ago and i am very concerned about the wording and descriptions on the report. This was my first mammo and ultrasound both diagnostic since my gyn thought she felt bilateral breast masses.

They found an enlarged lymph node in right breast 3x5x7 with a thickened vascular cortex. No mass noted. Fna is scheduled. In my left breast they found a microlobulated hypoechoic mass 5x7x10 and also subcentimeter asymmetry in lower central region. Bx scheduled.

My question is should i be worried they missed a mass in my right breast? Or if my left breast mass is malignant could it spread to a right breast lymph node? Could this enlarged lymph node just be nothing at all and just worried for nothing. Im 40 and healthy. The radiologist made me do a second mammo on left breast because i have heterogenously dense breasts and they wanted better pics of mass. Result was birads 4.

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Oct 7, 2018 03:13AM djmammo wrote:

jsacks

Can you post the entire mammo and US reports?

Board Certified Diagnostic Radiologist specializing in Breast Imaging. Contact me at DJMammo@gmail.com

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