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The Neck Scan: A Reassuring Check

Specialist neck ultrasound to investigate PET/CT findings - one tiny node that might not even be involved, everything else completely clear

The Neck Scan: A Reassuring Check

Late November 2025. The PET/CT scan had just revealed the extent of lymph node involvement - not just in the armpit, but tracking up through the subpectoral area and into the lower neck, reaching as high as C7 vertebra (the base of the neck).

The original breast surgeon, Mr. Thiruchelvam, reviewed the PET/CT and MRI findings and made a smart decision: bring in a specialist neck radiologist for detailed ultrasound assessment.

This isn’t because the news got worse. The PET/CT already showed us the neck involvement. This is good medicine - when you have a specialist available who can provide millimeter-precise mapping of the neck anatomy, you use them. The neck is complex territory, and having an expert who looks at neck lymph nodes all day, every day, means we’ll have the most accurate information possible for treatment planning.

Another scan. Another specialist. But also: another layer of precision.

The Scan

December 16, 2025 - King Edward VII’s Hospital

Four days after starting chemotherapy, the neck ultrasound appointment with Dr. Ashok Adams, a specialist neck radiologist.

The PET/CT had reported “a few small involved right lower posterior neck nodes.” Dr. Adams was tasked with finding them, characterizing them, and potentially taking a biopsy (fine needle aspiration) if appropriate.

Ultrasound is perfect for this - it shows lymph node architecture in detail. Shape, size, internal structure, blood flow patterns. It can distinguish between normal/reactive nodes and pathological ones.

The Results: Much Better Than Expected

What they found:

  • ONE small lymph node in the right posterior triangle (level 5B): 3 mm in size
  • Does NOT look overtly pathological on ultrasound criteria
  • Normal features: Hilar blood flow preserved, no cystic changes (good signs)
  • Could be reactive (just inflamed/benign) rather than cancer involvement

What they DIDN’T find:

  • No other pathological neck lymph nodes
  • Thyroid gland: Normal
  • Salivary glands: Normal
  • All other neck structures: Normal

Translation: The PET scan said “a few nodes” in the neck. The specialist ultrasound found ONE tiny 3mm node that doesn’t even look obviously cancerous, and everything else is completely clear.

The Plan

Too small to biopsy safely: At 3mm and in a tricky location, attempting to stick a needle in it carries more risk than benefit.

(A small relief - another needle, this time in the neck, wasn’t something I was looking forward to. One less procedure to endure.)

Already on treatment: We started chemotherapy four days ago. If this tiny node is involved with cancer, the chemo will treat it. If it’s just reactive/benign, it will stay stable or resolve on its own.

Repeat ultrasound in 6-8 weeks: Monitor for interval change.

  • If it shrinks → confirms it was involved and treatment is working
  • If it stays the same → likely benign/reactive all along
  • Either way, we get our answer without risky procedures

Why This is Good News

When the surgeon first mentioned a neck specialist referral, it sounded ominous. “The PET showed lymph nodes up to C7 in the neck - we need a neck specialist to map them precisely.”

But the detailed ultrasound by a neck expert found much less than the PET suggested:

  1. ONE tiny node (not “a few”)
  2. Doesn’t look cancerous on detailed assessment
  3. Everything else perfectly normal - thyroid, other nodes, all neck structures
  4. Already being treated - if involved, chemo addresses it
  5. We’ll watch it - repeat scan will tell us if it was involved or benign

PET scans are very sensitive - they “light up” anything metabolically active, including reactive/inflammatory nodes that aren’t cancer. Ultrasound provides the detail to distinguish them. In this case, the ultrasound is reassuring.

The Bigger Picture

This scan was done four days after starting treatment. The timing actually works in our favor - we have a baseline, and in 6-8 weeks we’ll see treatment response across the board.

The extensive lymph node involvement we’re treating is in the axilla (armpit) and subpectoral area - that’s where the disease burden is. This one questionable tiny node in the lower neck? Even if it is involved (and it might not be), it’s being treated with the same systemic chemotherapy that’s targeting all the other nodes.

The treatment doesn’t change. The plan doesn’t change. We continue forward.

And we do it with the reassurance that a specialist looked at the neck in detail and found things much less concerning than the PET/CT suggested.

Next Steps

  • Continue chemotherapy as scheduled
  • Repeat neck ultrasound in late January/early February 2026
  • Compare findings to assess treatment response
  • No immediate concerns requiring action

Scan Date: 16 December 2025
Hospital: King Edward VII’s Hospital
Result: Reassuring - one tiny node, doesn’t look pathological, everything else normal
Plan: Monitor while continuing treatment