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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Apr 20, 2019 05:49AM bow1965 wrote:

marijen = I don't have the report yet and it's not yet posted on MyChart. It was Friday afternoon when I got the request for follow-up, it should get posted this weekend or early next week. I find this highly annoying about online records, they can see at the office but it's not immediately accessible to the patient until it's "released" by a health professional. Suppose that helps to only release after the team talks to the patient but UGH. I'm just going to put on my best chill face and meditate my way to Monday when I can get my hands on it.

Dx 3/2014, IDC, 3cm, Stage IIIA, Grade 2, 4/9 nodes, ER+/PR+, HER2- Surgery 4/23/2014 Lymph node removal; Lymph node removal (Left); Mastectomy; Mastectomy (Left) Chemotherapy 5/19/2014 AC + T (Taxol) Radiation Therapy 9/15/2014
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Apr 20, 2019 10:57AM - edited Apr 20, 2019 11:17AM by marijen

When you get your results you can post them here for Djmammo. Lymph nodes swell for other reasons. You can search Why Lymph Nodes Swell. I hope everything turns up negative. Try to enjoy the weekend!


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Apr 23, 2019 05:45PM bow1965 wrote:

Following are the results from my mammogram, I will be having contrast mammogram and an ultrasound in two weeks. Will post those results as well, the more information we can share the better I think. Thanks!

MAMMOGRAM: Interpretation is performed utilizing computer-aided detection. Standard digital Right CC and MLO views were obtained. There are scattered areas of fibroglandular density.

No suspicious mass, suspicious calcifications or unexpected architectural distortion. Question mildly prominent right axillary lymph nodes.

Dx 3/2014, IDC, 3cm, Stage IIIA, Grade 2, 4/9 nodes, ER+/PR+, HER2- Surgery 4/23/2014 Lymph node removal; Lymph node removal (Left); Mastectomy; Mastectomy (Left) Chemotherapy 5/19/2014 AC + T (Taxol) Radiation Therapy 9/15/2014
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Apr 23, 2019 06:39PM marijen wrote:

Bow, I hope the next tests are more definitive.


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Apr 23, 2019 06:58PM bow1965 wrote:

marijen, me too. I will be asking the questions about mammogram distortion considering the concern seems to be the size of the node and not the structure. This was the least "ow you're killing me" mammogram I've ever had haha. Really though, I wonder. Also wonder about lymphocytic leukemia, which my father had...ugh. At any rate, I am at peace with this report and feeling pretty chill about the follow-up tests. It's been enough scanxiety situations for me in the last 5 years that I've learned to experience the chill. Surgery was 5 years ago today, I just realized! Woohoo!

Dx 3/2014, IDC, 3cm, Stage IIIA, Grade 2, 4/9 nodes, ER+/PR+, HER2- Surgery 4/23/2014 Lymph node removal; Lymph node removal (Left); Mastectomy; Mastectomy (Left) Chemotherapy 5/19/2014 AC + T (Taxol) Radiation Therapy 9/15/2014
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Apr 24, 2019 03:34AM djmammo wrote:

Bow1965

The description of the nodes is vague. Mildly prominent is a poor description. It doesnt say which feature is prominent.

The upcoming US should evaluate the overall size of the node, the thickness of the cortex and a description of the central fat within the node in order to be complete.

And yes in cases of breast cancer the mass in the breast is usually detected before the lymph nodes are visibly affected.

As far as leukemia is concerned, have you had a CBC in the recent past? It would be more common to have nodes enlarged on both sides not just one, if that were the case.

Board Certified Diagnostic Radiologist specializing in Breast Imaging. Contact me at DJMammo@gmail.com
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Apr 24, 2019 05:10AM bow1965 wrote:

Thanks for responding, djmammo. I have CBC every 6 months, last one in January and expected again in July. I have had an L mastectomy with lymph node removal therefore no mammogram on that side. My counts are normal high (WBC in particular) with no spikes or areas of concern and no symptoms of systematic disease. I am high risk with self, mom, grandma BC and I'm hoping that is the catalyst (less than a huge red flag, more of a cautionary approach) for having another look. We shall see

Dx 3/2014, IDC, 3cm, Stage IIIA, Grade 2, 4/9 nodes, ER+/PR+, HER2- Surgery 4/23/2014 Lymph node removal; Lymph node removal (Left); Mastectomy; Mastectomy (Left) Chemotherapy 5/19/2014 AC + T (Taxol) Radiation Therapy 9/15/2014
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Apr 30, 2019 03:44PM PalBuddy wrote:

I had my one year followup to my surgery. Nothing on the Mammo but the MRI showed a slightly enlarge (less than 1 cm) axillary lymph node. So, they did an ultrasound biopsy.

Results were: Negative for malignant cells; lymphocytes present; sparsely cellular specimen. Satisfactory for evaluation.

I thought great! No cancer recurrence! But, they also want me to have a PET scan on Friday because there can be a "false negative". Sigh. I had about 45 minutes of being out-of-fear, and now right back to anxiety. I hope they are just covering all bases, but am not sure. Anyone had this? Thanks.

Dx March 2018. Left breast, 3 tumors -1.3cm, 1.2cm, 0.8cm. ER+PR+ HER-. Stage 1, Grade 3. Lumpectomy & Radiation. On 5 years of AI Letrozole. Oncotype: 19.
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Apr 30, 2019 04:30PM marijen wrote:

Wow I have one lymph node that is over 2cm and they say that's a normal size! I've had it US'd 4 times plus two MRI's but they won't do a biopsy.

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May 6, 2019 08:08AM bow1965 wrote:

PalBuddy I hope your PET went well. It's such a dichotomy, being happy that we are watched closely but dealing with the stress of scans. Thinking of you.

Dx 3/2014, IDC, 3cm, Stage IIIA, Grade 2, 4/9 nodes, ER+/PR+, HER2- Surgery 4/23/2014 Lymph node removal; Lymph node removal (Left); Mastectomy; Mastectomy (Left) Chemotherapy 5/19/2014 AC + T (Taxol) Radiation Therapy 9/15/2014

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