There has got to be some margin of error, so that perhaps they can say that 3.1 is effectively the same as 3.3. But I don't see how 1.4cm going to 2.6 can be called unchanged. The same for 2.1 going to 1.5. But that one also seems an odd thing to happen, when no other dimension gets smaller. Cancer would not get smaller like that, so it would have to be a reduction in inflammation or else more likely just operator error/variance.
I'd have to guess that the radiologist is just assuming that the changes are due to operator error/variance, since the architecture remained the same. Researchers actually do run studies where they have more than one operator scan the same node(s), and then they calculate the amount of variability between operators. New sono techs are more likely to make inaccurate measurements.
Btw, an echocardiogram is also ultrasound. I've seen more than one real life case where the results were way wrong, in which instance they either have a very experienced MD redo it or else they switch to a more accurate type of scan (MUGA, which uses radiation not sound).
The 2.6 is the short axis. So that 0.8 ratio is indeed over the line of having an oval ratio of 0.5 Except that normal submandibular nodes tend to be rounded anyway.
But, the May 10 report you posted says, "unchanged" from Feb 12. Why is that, when you say they are not the same?
Also, why does the May 10 only report the size and nothing else? Seems odd.
Can you post a list of dates and 3d sizes for every US you've had? How many report on cortical thickness?
Overall, the false negatives of head and neck FNB are ~7% odf all FNAs done. Of all those who did end up having a metastatic cancer, 44% started out with a false negative FNB. Younger patients had more false negatives.
"false negative" means the FNB says there is no cancer, but there really is cancer.
I've never seen anyone else's US report mention cortical thickness. I would have guessed that has gone by the wayside - possibly because it has to do with absolute size which is not a good indicator.
FNA is good for ruling in cancer, not as good for ruling it out. A negative FNA would usually mean there will be no followup excisional biopsy, unless there was somehow strong evidence otherwise to suspect cancer.
The accuracy of FNA for thyroid metastasis increases if they chemically look for thyroid hormone in a node, not just microscopically look at the cells. You can check the FNA path report to see if they did check that, they probably did.
US findings are just a matter of probabilities, while the only way to know for sure is with excision -- though sometimes even then the pathology report is equivocal. It is rarely possible that a node looks benign on US, while in reality it is lymphoma. Here's such a case: https://www.youtube.com/watch?v=yskqbVbYo5A Here's another in Figure 4: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5392555/
Just guessing that it's 1/1,000 or even 1/10,000 of benign US reports, but it happens. A cancer can do almost anything. The same for the immune system.
A metastatic node is pretty much the same as a lymphoma node, except in metastasis there is more likelihood of flecks of calcifications, and new blood vessels. Nothing is absolute.
"That rules out other cancers right? I know it’s not always reliable for finding lymphoma but for like thyroid cancer or cancer from another location it’s pretty solid right?
I don't think so: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4276754/ "Overcoming the Limitations of Fine Needle Aspiration Biopsy: Detection of Lateral Neck Node Metastasis in Papillary Thyroid Carcinoma"
Or, that could be the double which was said to not be true - but maybe it is true. If you ever get another US, ask that it be done from more than one direction. Or a CT should be able to do that.
It's far more likely for a benign node to look bad, than a cancerous node to look good. But since I've always been honest with you and not just singlemindedly optimistic... then if you like I can play devil's advocate and make a case that it is bad but looks good. That's very unlikely but still very remotely possible.
Ok, so we can accept that it truly is 3.1cm long.
"3.1 by 1.1"
That is very good as far as being oval and not rounded. The ratio of l/w should be 2 or better. That's 2.8. For some reason, reactive nodes get longer in an orderly way, but cancerous nodes get rounded because they grow in all directions willy nilly.
"how big does one have to get before it’s worrisome?"
You can try finding a study where they measure reactive nodes and give all the individual data, not just summary data.
"Also does US usually even show nodal changes in lymphoma?"
Yes, as discussed many times before. A node filled with cancer cells will look different on US than a normal reactive node.
Try looking here at cancerous nodes:
"it’s looking like a low grade is more likely given the growth isn’t it?"
Nope. What I'd say is that the inflammatory process that is driving the reactive process inside the node (and making more immune cells as they benignly proliferate) is still ongoing. It's not composed of just inert fibrosis inside.
There is such a thing as chronic histoplasmosis. This paper says that histoplasmosis might cause sarcoidosis, or that one might be mistaken for the other because they are so similar: https://www.hindawi.com/journals/crirh/2015/108459/
Sarcoidosis can cause neck nodes. It is a mystery immune condition. I bring this up to reinforce that the immune system can cause unusual things and is not well understood.
Yes, I remember the sono and how to my untrained eye it looked perfectly normal.
Here's a thought: you can look into whether there are any exosome tests for lymphoma that are now available beyond the research environment. Exosomes are molecules that cells exude and end up in the blood. There are such tests for prostate cancer.
Hi, Spartan. I don't know how you could get an excisional biopsy, except if by chance you see a very lenient doctor; but even then the surgeon would also have to go along. So it's not likely.
On the other hand, size is not the most relevant factor. And btw US is not completely accurate, with operator variability the biggest possibility for different readings on length, IMO. If you've looked at actual sono images, there seems many times where the marker could be placed this way or that. I know there have been studies done where different operators measure the same node, and then the variance is calculated. For something really crucial, an experienced MD is better than a novice US tech.
Or the size increase could be accurate yet the node is still very benign - which I would guess is the case.
But the length is not crucial here, as the shape and the internal architecture are more important and are apparently still okay. There is that video talk I'd recommended long ago, on US of nodes. I think if you mastered that by listening to it a few times, you could be more assured.
There are also lung granulomas in the mystery immune condition called sarcoidosis.
But most likely is that the chest infection you had is still somehow driving the neck nodes.
Let's see... easy bruising, neck nodes, lung granulomas, infection kicked it off, very lean. Take a look at the recent post here, "Just to vent .... and see if a biopsy is warranted" by Caris, which is similar to you.