Lymph Node Concerns: Key Insights from Ultrasound Findings

Lymph Node Inquiry

The ultrasonography (US) of the bilateral neck and US-guided fine needle aspiration for cytology (FNAC) shows: 1.
A prominent lymph node in the right neck IA (short axis: 0.9 cm), differential diagnosis: reactive node, lymphadenitis, or malignant lymphadenopathy, status post US-guided FNAC.
2.
Small benign-looking lymph nodes in the remaining parts of the bilateral neck.
3.
Small hypoechoic nodules in the bilateral parotid glands (right: up to 0.4 cm; left: up to 0.6 cm), differential diagnosis: lymph nodes, small tumors.
4.
Unremarkable findings in the bilateral submandibular glands.
5.
Tiny colloid cysts in the bilateral thyroid (up to 0.2 cm) and an eosinophil count of 5.4 in the blood report (the normal range provided by the hospital is 0-5).
Hello, Doctor.
The above is my current examination record.
Recently, I noticed a new lymph node that is larger than the previous ones, is relatively immobile, and feels firm, which has caused me considerable concern.
I went to the hospital for an examination.
During the ultrasound, the doctor mentioned that there is a lymph node measuring 0.9 cm that is difficult to visualize, and therefore suggested a fine needle aspiration biopsy.
However, the waiting time is long, and I seem to have a tendency towards health anxiety.
Based on the information provided, do you think the likelihood of malignancy is high? Also, regarding the lymph node I am worried about, is the 0.9 cm measurement referring to the short axis or the longest axis? Lastly, I would like to ask if a lymph node that is firm and relatively immobile has a higher probability of being malignant.
Thank you for taking the time to respond.

Xiao Lin, 20~29 year old female. Ask Date: 2023/12/28

Dr. Zheng Jueyi reply Otolaryngology

Hello, there are many factors that can cause lymphadenopathy, and it is not possible to accurately determine whether it is benign or malignant based solely on size, hardness, or mobility.
It is recommended to wait for the results of the biopsy report, after which the clinician can decide whether regular follow-up is necessary or if further treatment is required.
Additionally, lymph nodes are typically oval-shaped, with 0.9 cm being the length of their short axis diameter.

Reply Date: 2023/12/28

More Info

When it comes to concerns regarding lymph nodes, particularly in the neck area, it is essential to understand the implications of ultrasound findings and the potential need for further evaluation. Based on the ultrasound report you provided, there are several key points to consider.

1. Understanding Lymph Node Characteristics: The ultrasound findings indicate a prominent lymph node in the right neck measuring 0.9 cm in its short axis. It is crucial to note that the size of a lymph node alone does not determine whether it is benign or malignant. Lymph nodes can become enlarged for various reasons, including infections (reactive lymphadenopathy), inflammation (lymphadenitis), or malignancy. The differential diagnosis (DDx) provided in your report suggests that the prominent lymph node could be reactive, indicative of a benign process, or potentially malignant.
2. The Importance of Fine Needle Aspiration (FNA): The recommendation for a fine needle aspiration (FNA) is a common approach when there is uncertainty regarding the nature of a lymph node. FNA allows for cytological examination of the lymph node tissue, which can provide valuable information about whether the lymph node is reactive or if there are malignant cells present. While waiting for the procedure may be anxiety-inducing, it is a critical step in obtaining a definitive diagnosis.

3. Interpreting Size and Mobility: You mentioned that the lymph node you are concerned about is hard and not very mobile. While these characteristics can sometimes raise suspicion for malignancy, they are not definitive indicators. Lymph nodes can be firm and less mobile due to various benign conditions, such as chronic inflammation or fibrosis. The short axis measurement of 0.9 cm refers specifically to the shortest diameter of the lymph node, which is a standard way to report lymph node size in imaging studies.

4. Eosinophil Count: Your blood test indicated an eosinophil count of 5.4, which is slightly elevated above the normal range (0-5). Eosinophils can increase in response to various conditions, including allergies, infections, and certain autoimmune diseases. While this finding may warrant further investigation, it is not directly indicative of malignancy.

5. Next Steps: Given your concerns and the characteristics of the lymph node, it is advisable to follow through with the recommended FNA. This procedure will help clarify the nature of the lymph node and guide any necessary treatment. If the FNA results are benign, your healthcare provider may recommend monitoring the lymph node over time, especially if there are no other concerning symptoms.

6. Consultation with Specialists: If you continue to feel anxious about your condition, consider discussing your concerns with a specialist, such as an otolaryngologist (ENT) or a hematologist/oncologist. They can provide further insights and reassurance based on your specific case and the results of the FNA.

In summary, while the ultrasound findings and your symptoms may raise concerns, the definitive diagnosis will come from the FNA results. It is essential to remain proactive in your healthcare and follow the recommendations of your medical team. Regular follow-ups and open communication with your healthcare providers will help ensure that any potential issues are addressed promptly.

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