The area of asymmetry at 12 o'clock is now palpable and the patient is sent for diagnostic mammography.
The salient point here is not how the nodes are denser, but not bigger? The nodes in the apex of the axilla are still normal with fatty hila.
The abnormal nodes are a red flag. You should be looking for a focal lesion in the breast. Do not be tempted to discount this finding in every day practice.