MRI to find Lymph Node Involvement

Sd2906 · September 2017

Hi our doctor did an MRI to find lymph node involvement and the results came back as unclear. They now want to do an FNA and ultrasound to get further clarity. Has this happened with anyone else? Why wouldn't the MRI show node involvement? It just seems a little weird to us that the MRI can't confirm it.

Our oncologist says this is a good outcome but we can't understand why...

MTwoman · September 2017

Sorry that you are still in the collecting information stage, which can seem to drag on and be confusing! Imaging is never the definitive answer, biopsy always has the final say. You might be concerned about imaging results, or imaging results may suggest (even strongly suggest) that there are (other) areas to biopsy, but mri don't really "confirm" involvement. So the unclear might mean that they got some sort of slight (perhaps within normal limits) deviation in size or the exterior margins of a node, or that the uptake/wash out kinetics weren't clearly b9 or malignant, but somewhere in the middle. I would bet the oncologist is saying "good outcome" because there aren't clear signs of nodal involvement. the oncologist is ordering the biopsy to confirm that they aren't involved, not to confirm that they are. Does that make sense? good luck!

Sd2906 · September 2017

thank you MT. That's helpful. My wife was breastfeeding so I guess they are trying to see if it's from breastfeeding vs something more definitive.

I spoke to my oncologist again. He basically said what you said above. He said there still could be involvement but it would likely be less pervasive than if the MRI showed clear involvement

MTwoman · September 2017

breast feeding does make imaging more complicated. I do hope they find the nodes clear!!

Outfield · September 2017

This is an oversimplification, but a lot of times doctors use the slang "light up" when referring to something like a lymph node that looks concerning on a scan, and I think it can be a useful way to think about scans. Nodes with cancer don't truly "light up," but very diseased nodes (or masses) can look very bright on a scan compared to the tissues nearby. There are ways to measure this "brightness," and to describe the edges of it, both of which are relevant for evaluating lymph nodes, but aren't really important for understanding the general concepts of how the MRI results help you. Think of turning on a fluorescent light in a dark room - that kind of contrast is what we hope (or really more, hope not) to see.

The problem is that we expect lymph nodes with a lot of cancer to be big and usually "light up" a lot, and lymph nodes without cancer to be small and not to "light up" at all, but there are many areas in-between. There are a lot of things that don't look like the dark room or the fluorescent light; they look like candles, or flashlights. The scans themselves are different shades of white, grey and black. Imagine hoping to see white or black, but what you see is grey. That's where you are. There are all sorts of things that can result in a node looking somewhere in-between utterly normal and very abnormal. A little bit of cancer is one of those things, but it's by far not the only one.

It's not weird at all that the MRI isn't giving you a big push toward an answer of "yes" or "no." It just means you are in that grey area, both literally and figuratively. It's also important to keep in mind that the MRI is never the last answer to whether nodes are involved or not - the only way you know for sure is a pathologist looking at the node or a little bit (biopsy) of the node. The MRI helps a lot in knowing the probability that a node will have cancer in it, but the result helps most if it's not an in-between appearing node.

Your result is "good" because you did not have a node (or nodes) that looked very, very abnormal. That's good. It's better not to have cancer in the lymph nodes, but if it's there, it's better to have only a little than a lot.

I hope this helps and isn't more confusing. I wish you the best.

pupmom · September 2017

MRI did not find either of my positive lymph nodes. It's not a perfect test. Best wishes for the FNB!

Sd2906 · September 2017

outfield thank you. That's the most thorough and complete MRI explanation I've ever seen.

Pupmom, thanks for your response. May I ask how large the lumps were in those two nodes they found?

Thank you everyone

pupmom · September 2017

Sd2906, my nodes had micromets, probably the reason they were not seen on every imaging device. Still, I officially have 2 nodes positive.

Sd2906 · September 2017

thanks pupmom. That makes sense

Chips530 · September 2017

I was just beginning to get my nerves somewhat under control after my diagnosis 2 weeks ago ,then went to the surgeon yesterday.The things he said about the cancer surgery(lumpectomy) were ok, but he wants me to have a M.R.I. just as a safety measure.Now I'm shaking inside & out just like when first diagnoised.I have had 3 M.R.I.'s in my life, & after the last one,I swore that I would never have another one--bad,bad panic attack.We have an openM.R.I. here in Owensboro,but I called there & they said can't get good readings for breasts.I was wondering if this is absolutely necessary for having a lumpectomy? Thanks

pupmom · September 2017

Chips, it's hard to comment since you haven't completed the diagnosis section of your profile. I had an MRI right after being diagnosed, because I was initially thought to be ILC, which tends to affect both breasts.

MTwoman · September 2017

chips, I agree with pupmom, it would be much easier for us to give you helpful information if we better understood your personal stats. If you would fill in as much as you know and make it public, that would help. But I will share with you my mri story, not knowing if it pertains to your situation very well or not. I chose lx for my surgical option and was preceding to rads when my second opinion pathologist recommended an mri to see if there were any other areas of concern as the architecture pattern of my dcis tends to be multi-focal. He was right. They found 2 more areas of concern in a separate quadrant that turned out to also be dcis. So I ended up needing a mx. If I hadn't had the mri, I wouldn't have known about the 2 areas and would have proceeded to rads with cancer cells still in tact. It is very possible I would have had a local "recurrence", which would really have just been cells that hadn't been removed. So when they recommend a breast mri, it is typically for good reason, and you want the best quality they can provide you. If it helps at all, when you get your breast mri'd, you are laying flat on your stomach with your breast through a cut out on the table. You go in feet first so that your head is at the opening. I had my hands above my head, but I did read that someone else didn't because of the location of her tumor. Hope that helps!

Chips530 · September 2017

Thanks pupmom for your reply (your baby is precious ,by the way I have a little rescue chi)I will get the rest of my profile filled out ,I don't even know what ILC is ,so I have a lot to learn.The surgeon's nurse finally called me & helped make me feel better about not having an M.R.I .It's not that I just don't want to have it, I know I have very bad panic attacks during one & I checked with Radiology & they can't get good results with an open M.R..I.

Sara536 · September 2017

Chips, Having had a panic attack (unrelated to cancer or MRI), I can understand not wanting to have another one. Did you ask about getting a sedative to help get you through? And is there the right kind of MRI equipment in another town that you can get to? Since an MRI is physically noninvasive, and has been recommended by your surgeon,, I would not pass it by. The more information the surgeon has before surgery the better.

Sd2906 · September 2017

thank you for all your posts and advice. It's been so invaluable as we deal with the early stages of uncertainty and fear.

To give you an update, my wife had two enlarged nodes and the largest was 1.8cm. They tested the node with a biopsy and the result was benign. So while she has a large high grade tumor in her left breast, it appears the lymph nodes were not affected (though micromets is always possible). Ultrasounds, MRIs and biopsies can't tell us for sure, but it seems better than we had expected.

Thank you again.

Kahnartist · September 2017

I had one eve other day. Also recently diagnosed and he wanted more info. You lay face down and you can't really tell you are in the tube. Ask for a sedative from your doc. It was so much better than the one I had for migraines. Please don't worry and do it. It is not that bad!!

Chips530 · September 2017

Thanks Kahnartist for your reply.I'm still waiting for the surgeon's nurse to call me back.She told me Friday hat she will call me & let me know what the surgeon says.She made me feel better when she said "lots of other people can't have a M.R.I. for all kinds of reasons"I just want to get this lumpectomy over.

Kahnartist · September 2017

Chips530,

I feel you. I want this whole thing over. I forgot what it feels like to be normal and it has only been a week.

MRI to find Lymph Node Involvement

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