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 02:40PM

Posted on: Nov 15, 2017 02:40PM

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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Mar 11, 2019 10:16PM djmammo wrote:

georgie1112

There is no abnormal description in your report if thats what your question is.

Board Certified Diagnostic Radiologist specializing in Breast Imaging. Contact me at DJMammo@gmail.com
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Mar 12, 2019 06:27AM rah2464 wrote:

Thank you djmammo for this wonderful information ! Once again, you and the others who post information on this forum educate me as I take another step in this journey and I am so thankful for your efforts.

I had quite the surprise at my 9 month post op ONC appointment. I mentioned to her that about a month ago I experienced a sore underarm lymph node on my cancer side. The soreness resolved after a couple of days. I mentioned to my oncological massage therapist and she felt I had overused the arm and possibly had some lymphatic congestion. My Oncologist yesterday, however immediately checked the area and found two nodes she felt were swollen. So wednesday I have my first axillary ultrasound. But I think if I have to choose between lymphedema and C, well lets take option #1.

And after doing some research that SNLB is about 90 - 94% effective, I do wonder why ultrasound imaging prior to surgery is not a standard step? I know the likelihood is smallish to miss the path the cancer takes but it seems logical to me to add this option. It would be interesting to hear your opinion. I would think that if my swollen nodes are positive, that we missed this somehow as I am not that far out from surgery.

Dx 5/23/2018, IDC, Left, 1cm, Stage IA, Grade 2, 0/4 nodes, ER+/PR+, HER2- Surgery 6/27/2018 Mastectomy; Mastectomy (Left); Mastectomy (Right); Reconstruction (Left): Silicone implant; Reconstruction (Right): Silicone implant Hormonal Therapy 7/27/2018 Tamoxifen pills (Nolvadex, Apo-Tamox, Tamofen, Tamone)
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Mar 12, 2019 07:12AM djmammo wrote:

Rah2464

In my practice when a malignancy was identified in the breast on US, we always examined the nodes in that axilla and report their appearance. The sentinel node is determined by the injection of a tagged material that is taken up by the lymphatics. The sentinel node is removed along with any that we indicated looked abnormal on US.

A node can contain cancer cells and appear normal on US. Since US is an 'anatomic' exam (based on size and shape) the node does not appear abnormal until a threshold number of cancer cells have entered the node to thicken its cortex and compress its fatty hilum. I don't know what that number is but thats what microscopy is for. This renders US unreliable to exclude spread to the nodes if the node looks normal. You can biopsy the node at US but if there are not enough cancer cells present, and you miss them on bx you get a false negative. We can assume the lowest node we see on US is the sentinel node but again this is unreliable.

The sentinel node exam using the radiotracer, is a 'physiologic' study assessing function not appearance. It tells us the first node that the cancer would enter, the path the cancer would take on its way out of the breast, and is our best shot at determining if 'the horse got out of the barn' no matter what it looks like on US. Not sure how many other nodes are taken if they all 'look' normal on US. A certain percentage of pt's will get arm swelling with an axillary node dissection that is purely mechanical, unrelated to the presence of tumor. Not sure if that would cause otherwise normal nodes to enlarge due to lymphatic obstruction but I suppose thats possible.

Do they want to remove those nodes or bx under US?

Board Certified Diagnostic Radiologist specializing in Breast Imaging. Contact me at DJMammo@gmail.com
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Mar 12, 2019 07:30AM rah2464 wrote:

I am not sure. I am only scheduled for the US, then will have a follow up consult with the BS if imaging indicates further investigation is needed, which I assume would then be some type of biopsy.

Dx 5/23/2018, IDC, Left, 1cm, Stage IA, Grade 2, 0/4 nodes, ER+/PR+, HER2- Surgery 6/27/2018 Mastectomy; Mastectomy (Left); Mastectomy (Right); Reconstruction (Left): Silicone implant; Reconstruction (Right): Silicone implant Hormonal Therapy 7/27/2018 Tamoxifen pills (Nolvadex, Apo-Tamox, Tamofen, Tamone)
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Mar 13, 2019 03:50PM rah2464 wrote:

All nodes imaged were classified normal based on US imaging. So no further testing, but I am to report any changes. Thanks for your input djmammo.

Dx 5/23/2018, IDC, Left, 1cm, Stage IA, Grade 2, 0/4 nodes, ER+/PR+, HER2- Surgery 6/27/2018 Mastectomy; Mastectomy (Left); Mastectomy (Right); Reconstruction (Left): Silicone implant; Reconstruction (Right): Silicone implant Hormonal Therapy 7/27/2018 Tamoxifen pills (Nolvadex, Apo-Tamox, Tamofen, Tamone)
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Mar 14, 2019 04:39AM blah333 wrote:

you can also just have a reactive/swollen node. That's what I have. It had to be biopsied and caused a great deal of stress. So it's not just lymphedema vs. cancer...


Age 35 at diagnosis Dx 9/2017, DCIS, Left, 6cm+, Stage 0, 0/2 nodes, ER+/PR+ Surgery 12/1/2017 Mastectomy; Mastectomy (Left); Mastectomy (Right)
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Mar 15, 2019 06:22AM rah2464 wrote:

Absolutely correct Blah333. Glad to hear your lymph node was clear of C.

Dx 5/23/2018, IDC, Left, 1cm, Stage IA, Grade 2, 0/4 nodes, ER+/PR+, HER2- Surgery 6/27/2018 Mastectomy; Mastectomy (Left); Mastectomy (Right); Reconstruction (Left): Silicone implant; Reconstruction (Right): Silicone implant Hormonal Therapy 7/27/2018 Tamoxifen pills (Nolvadex, Apo-Tamox, Tamofen, Tamone)
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Mar 22, 2019 07:38AM - edited Mar 22, 2019 07:39AM by jons_girl

Hi dmammo,

I had posted a new thread about my lymph node a day or so ago then I saw this explanation above! Thank you for taking the time to share the info and diagrams above! Very informative and helpful! I'm going to check my last ultrasound report. To see what it said last time I had it ultrasounded. I have another breast ultrasound in May. This time I'm doing automated ultrasound. The lymph node I have that isn't 'going down' in size is on my right side on edge of right breast by my ribs like I think at 7 or 8 o'clock. It's weird. Does not seem to be any smaller since last ultrasound. But still big enough to definitely feel it. I can see it when I lift my arm up.

I’m probably just being paranoid!

Breast cancer at age 49. Felt tumor. Wasn’t caught on mammo even after feeling tumor. Ultrasound caught my cancer. Dx 6/2017, IDC, Left, <1cm, Stage IA, Grade 1, 0/2 nodes, ER+/PR+, HER2- Surgery 7/5/2017 Lumpectomy; Lumpectomy (Left); Lymph node removal
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Mar 22, 2019 08:33AM djmammo wrote:

Jons_girl

As long as the imaging shows that the cortical thickness is ok, the fatty hilum is not effaced, and it does not enlarge further, I would not worry about it between scheduled follow up scans.

Board Certified Diagnostic Radiologist specializing in Breast Imaging. Contact me at DJMammo@gmail.com
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Mar 25, 2019 01:12PM jons_girl wrote:

Thank you djmammo. The fatty hilum was normal last time. I go in again in May and I am sure they probably will continue to keep an eye on it. It is a little creepy tho....to feel it. lol. Thank you for letting me know.

Breast cancer at age 49. Felt tumor. Wasn’t caught on mammo even after feeling tumor. Ultrasound caught my cancer. Dx 6/2017, IDC, Left, <1cm, Stage IA, Grade 1, 0/2 nodes, ER+/PR+, HER2- Surgery 7/5/2017 Lumpectomy; Lumpectomy (Left); Lymph node removal

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