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 12:40PM

Posted on: Nov 15, 2017 12:40PM

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 8, 2018 01:12PM jsacks wrote:

Djmammo, thank you so much for taking the time to review this report.. It means everything to me. You are making such a difference here on this forum for people. My results are as followed:

Technique: digital mammo diagnostic bilateral was performed. Targeting bilateral US was also performed.

Comparison: this is a baseline exam.

Findings: the breasts are heterogeneously dense, which may obscure small masses.

LEFT Mammo diagnostic bilateral: there is subcentimeter asymmetry seen in the lower central region of the left breast. No suspicious calcifications.

LEFT Breast US: US was performed for further evaluation of the imaging and reported clinical findings. Between 2:00 and 4:00, in the region of the reported palpable abnormality several cysts are seen with the largest measuring 8mm. At 5:30 3cm from the areolar margin there is a 5x7x10mm microlobulated hypoechoic mass which is clearly not seen on mammo images. In the area of the mammo asymmetry at 6:00 posteriorly there is no suspicious sonographic finding.

RIGHT mammo diagnostic bilateral. No suspicious mass, suspicious calcifications or other abnormality.

RIGHT US breast limited: targeted US of the breast was performed for further evaluation of the palpable mass identified on clinical breast exam. At 9:00 4-5 cm from nipple there is normal tissue planes without cyst or solid mass. However, at 9:30 9cm from the areolar margin there is a 3x5x7 mm lymph node with a thickened vascular cortex.

Impression: LEFT breast assessment suspicious biopsy recommended. 1. Indererminate hypoechoic mass at 5:00 identified on US should have US guided core biopsy recommended. 2. Mammographic asymmetry in the lower central breast which does not appear to correspond to the sonographic finding. No definet sonographic correlate os identified. If biopsy is benign follow up in 6mo is recommended. If biopsy malignant enhanced mri recommended.

RIGHT breast assessment: suspicious. Biopsy recommended. 1. Abnormal lymph node in the far lateral breast at 9:00. US guided FNA recommended. 2. No descrete sonographic finding in the reported area of palpable abnormality detected on clinical breast exam.

Well, there it is.. So gyn felt a lump on both breasts thats why i had the mammo and US. I cant feel anything because it feels like ribs under the tissue of both breasts. I am a nurse on a critical care floor so i care for patients who have had breast reconstruction with free flap and im scared. My grandmother died from unknown breast cancer and a few members of my family had BC as well.

Im worried about that enlarged lymph node on my right breast. Im not sick i havent been sick so that has me worried. But i dont know alot about cancer. I see the repair of cancer not the before and after. So can cancer from one breast spread to a lymph node on the other? The mass in left breast described microlobulated hypoechoic isnt reassuring especially when searching the web.

Any thoughts would be helpful. Biopsy and fna is scheduled 10/23. As of now gyn says its going to be fine.. I know this report doesnt feel fine. Id rather know whats happening?

Thanks again for everything...


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Oct 9, 2018 05:20AM djmammo wrote:

jsacks

Im worried about that enlarged lymph node on my right breast. Im not sick i haven't been sick so that has me worried.

They call it an abnormal node but without supporting evidence. The overall dimensions are not abnormal. They mention a thickened cortex but give no measurement which is the key feature. Normal lymph nodes are vascular and if you turn the Doppler settings up a bit they can look really vascular. No mention is made of the appearance of the fatty hilum so it might not be a lymph node at all. If a node is enlarged from something systemic, the axillary nodes would also be big as well as others elsewhere.

So can cancer from one breast spread to a lymph node in the other?

No.

The mass in left breast described microlobulated hypoechoic isnt reassuring especially when searching the web.

Firstly, dont search the web. Second, they dont say its cystic or solid and there is no mention or shadowing or through transmission so it could go either way, lobulated solid mass vs cluster of benign cysts and third dont search the web. And if you must search the web stick to reputable research sites such as ncbi.nlm.nih.gov. I would guess many of the authors of breast cancer related articles in popular publications dont really understand what they are writing but parroting information from source articles.

Let us know what the biopsies show.

Board Certified Diagnostic Radiologist specializing in Breast Imaging. Contact me at DJMammo@gmail.com
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Oct 9, 2018 07:14AM jsacks wrote:

Djmammo,

Thank you very much... I know its still wait and see but at least now i know what is happening and that means so much. I have to wait until 10/23 for biopsy and fna. I even scheduled an appointment in November with a breast surgeon just in case. Appointments through Penn medicine are always a month or more out so i wanted to be ahead of the game just in case. I already got out my hard cry and now i can sleep... So thank you again for this.. I will add you and everyone here in my prayers..




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Oct 9, 2018 11:25AM - edited Oct 9, 2018 11:25AM by SmallTownGal

Thank you for this information, djmammo! It does help.


Surely it is God who saves me. I will trust in Him and not be afraid.
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Oct 9, 2018 11:27AM SmallTownGal wrote:

I had an ultrasound today for an enlarged (2 cm) left axillary lymph node seen on 3D mammo. The mammo was otherwise unremarkable. The ultrasound tech said the node looked normal, just large. She even went in and checked with the radiologist to make sure she was imaging the correct area. I felt relieved until I came home and started Googling axillary lymph nodes and cancer. Now I am freaking out. I do currently have a sinus infection and also had a flu shot in the left arm just six days prior to the mammogram. I just wonder if I celebrated a little too early.

Surely it is God who saves me. I will trust in Him and not be afraid.
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Oct 9, 2018 11:58AM djmammo wrote:

SmallTownGal

The overall size is less of a concern than the thickness of the cortex. Does the report mention the thickness of the cortex? And yes the flu shot could cause a change in the nodes in the same-side axilla. I had a Rubella vaccine in 2009 in order to join the staff of a particular hospital and a few weeks later all my cervical nodes where big and tender, I had trouble moving my neck without pain. Turns out its a know side effect of that vax.

Board Certified Diagnostic Radiologist specializing in Breast Imaging. Contact me at DJMammo@gmail.com
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Oct 9, 2018 12:41PM SmallTownGal wrote:

No report as yet. I keep checking my online chart (where results are posted) but nothing yet. Also, no phone call from anybody as yet. I am going totally on the tech's assessment of the node as looking normal. But, I won't feel comfortable until I see a formal report. The longer I wait, the more I worry.

Does a long wait time mean an abnormal result? I keep picturing phone calls between the radiologist and my doctor, trying to figure out how to proceed. How long should it take to generate an ultrasound report? I've gotten normal digital mammography reports within 24 hours before--same facility.

Surely it is God who saves me. I will trust in Him and not be afraid.
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Oct 11, 2018 05:51AM SmallTownGal wrote:

Got the ultrasound report on the hospital system's online chart last night after 10 pm. It says benign 2 cm node recommend 1 year screening mammography. Yay! I only have access to the narrative portion of the report.

Surely it is God who saves me. I will trust in Him and not be afraid.
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Jan 23, 2019 01:27PM green71364 wrote:

Is it common for enlarged axillary nodes, that have 4 ultra sound tests on them, all recorded as fatty hilum and thin cortex, to remain forever? Its been two years.

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Jan 23, 2019 02:10PM djmammo wrote:

green71364

The overall size of a lymph node (length x width) is not that critical. It can be 2+cm and still be normal if there is a nice plump fatty hilum and a nice thin cortex especially if they have always been that size and they are not changing over time.


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

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