What Happens With Abnormal Lymph Nodes?

What Happens With Abnormal Lymph Nodes?

December 14, 2021
Everett Bonner, MD
Everett Bonner, MD

Breast Surgery



Your surgeon finds some abnormal clinical lymph nodes, which means they felt lymph nodes that feel abnormal. Most lymph nodes are pretty small, probably the size of a lima bean at best, usually smaller. But if they feel something that’s abnormal, something that’s large or that’s firm, or what we call bulky at times, it doesn’t always necessarily mean that the cancer has got into your lymph nodes.


Sometimes just from the biopsy itself, causes a reaction in the breast and you can have reactive lymph nodes. And that’s also common. But when you have a clinically positive lymph node, that means the surgeon or the physician felt a lymph node that feels abnormal.


The next step is the image of that lymph node. Because what we’re looking for is we’re looking for the architecture of that lymph node. Does it have a normal appearance? And there’s a few things that we look for that are very specific for, does this look normal or look abnormal? If it looks normal, then we say that’s probably a reactive lymph node. And we feel a little less likely that this is something of concern.


However, if its architecture or its view on an ultrasound is abnormal, we may want to biopsy that because it has a lot of indications on whether we go from surgery first or we go to chemotherapy or variants of both.


Key Takeaways

1. If your surgeon feels something that’s abnormal, it doesn’t always mean that the cancer is in your lymph nodes.

2. A clinically positive lymph node feels abnormal and the next step is to do imaging.

3. If it looks normal, that’s probably a reactive lymph node which is less concerning.

4. However, if it looks abnormal on an ultrasound is abnormal, we may want to biopsy.