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 11:40AM

Posted on: Nov 15, 2017 11:40AM

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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Jan 23, 2019 07:15PM green71364 wrote:

Thank you so much! You really are amazing!

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Feb 8, 2019 11:50AM - edited Feb 8, 2019 11:50AM by bbjkas

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Feb 8, 2019 11:50AM - edited Feb 8, 2019 11:51AM by bbjkas

@djmammo

I had an ultrasound and mamo recently due to a painful lump in my left breast. The dr said everything looks normal but I did notice some large lymph nodes on the ultrasound and based on the picture here I'm not sure if it's normal. I know it's not my place to look at that but I've had this painful lump for months now and I do feel like something is off in my breast so I don't feel comfortable with the dr's opinion that there's just nothing to see there.

Would you be willing to take a look at my lymph nodes ultrasound? And how can I send them to you?

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Feb 8, 2019 01:51PM djmammo wrote:

bbjkas

PM me the report if you can cut and paste or scan it in .

Board Certified Diagnostic Radiologist specializing in Breast Imaging. Contact me at DJMammo@gmail.com
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Feb 15, 2019 11:25AM kitkit wrote:

Hello all,

I am back after seven years without incident after my lumpectomy of left breast that showed early LCIS. No radiation. For the last few years I have had pain in area of surgery near left armpit. I have been followed up consistently with 6 month mammo and 6 month MRI. Every time I mention that I have continuing pain in area of lumpectomy it is attributed to scar tissue and/or nerve damage. A few weeks ago, as a result of MRI, mammo, and ultrasound, I've been told I have two suspicious axillary lymph nodes (2 cm) and one normal one in the same area. They have not shown up before. The concerning description of these nodes is that they are round and with no fat inside. I do not have symptoms of being ill; no weight loss, lots of energy etc. On Monday I go to have a needle biopsy using ultrasound. As I wait for the results I am, of course, researching the boards. My question: does anyone here have benign results from lymph nodes with no fat inside them? My hope, of course, is that I have had continuing infection that has never gone away from lumpectomy in the area. Am I being reasonable?

Thanks everyone

kitkit
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Feb 15, 2019 12:16PM djmammo wrote:

kitkit

In general if a particular node was normal in appearance on prior studies and now the central fatty hilum is completely effaced, one would worry about metastatic disease to the lymph nodes.

If all you had was LCIS this seems unlikely as LCIS is not cancer and does not metastizize. "Despite the fact that its name includes the term "carcinoma," LCIS is not a true breast cancer. Rather, LCIS is an indication that a person is at higher-than-average risk for getting breast cancer at some point in the future. For this reason, some experts prefer the term "lobular neoplasia" instead of "lobular carcinoma." A neoplasia is a collection of abnormal cells."

The other scenario is metastatic disease to a lymph node from an occult cancer in that breast. Usually the primary in the breast declares itself before a lymph node is visibly changed but not always.

If this finding you are describing is completely new, and does not correspond to a lymph node in that exact location on prior studies it may be a new primary, which would contain no fat.

As a rule infection enlarges the node but does not obliterate the central fat as you have described.

Board Certified Diagnostic Radiologist specializing in Breast Imaging. Contact me at DJMammo@gmail.com
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Feb 15, 2019 12:40PM kitkit wrote:

Thank you djmammo! I was hoping that you would reply!

I do understand that LCIS was not cancer.

"it may be a new primary, which would contain no fat." What does this mean?

My understanding is that the lymph nodes did not show up in prior studies because they were outside the area that was imaged. So, not sure of their prior condition.

Can you give me some positive possibilities I can dwell upon before I get needle biopsy this Monday? What benign condition(s) could cause these non-fatty lymph nodes?

Thanks so much,


kitkit
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Feb 15, 2019 01:14PM djmammo wrote:

kitkit

The key is to know if it were previously a normal lymph node but in this case I guess there is no way to know that. The hallmark of a normal lymph node is a plump fatty hilum with a thin cortex. Without the fat its either an abnormal lymph node or not a lymph node at all.

I have in the past seen small invasive ductal cancers arise near enough to the axillary lymph nodes to be mistaken for an abnormal lymph node. I have never seen a fibroadenoma near those nodes though I guess thats a possibility.

Let us know what the bx shows.

Board Certified Diagnostic Radiologist specializing in Breast Imaging. Contact me at DJMammo@gmail.com
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Feb 15, 2019 01:28PM kitkit wrote:

Thank you. I will advise next week.

kitkit
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Feb 15, 2019 03:49PM - edited Feb 28, 2019 03:05PM by jp18

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