I have been reading a lot about sentinal node biopsy. I was hoping someone could explain this to me and how it relates to DCIS. I was diagnosed last Monday after stereotactic biopsy with DCIS grade 2 (some comedo necrosis and cribiform pattern) as well as LCIS.
When I saw the surgeon they led me in the direction of "standard of care" which is lumpectomy with radiation. Masectomy was never mentioned although I did tell them I wanted a breast reduction at the same time. I have always had large breasts and felt this was the opportunity to make lemonade out of lemons. When I saw the PS I asked him what he thought. I knew reduction scars could show calcifications down the line from the healing process and was told that I could end up with unneccessary biopsies etc. (not to mention I would always worry about cancer coming back in to my life with the LCIS lurking around)
I knew what I really wanted to do was make sure I treated this cancer as aggressively as possible. I asked the PS about bilateral masectomy with immediate reconstruction and he supported my opinion wholeheartedly. I left the office feeling very good about my decision. The PS office was going to contact my surgeons office and let them know of the change and work together to schedule a surgery date.
Since I havent seen the surgeon since, Im wondering about SNB? Is this something that I should pursue with my diagnosis and with the change of treatment plan going to the more aggressive bilateral masectomy?
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roseg Joined: Sep 2004 Posts: 7435 |
Apr 27, 2008 11:23 am
roseg wrote:
Susan Love addresses this question in her book. She says if you have a lot of DCIS that really "shines" on a mammogram and are having a mastectomy then a SNB may be a good decision. ANY breast surgery puts you at risk for lymph edema, even a simple mastectomy where no nodes are removed. While the risk is not as high as if you have a full dissection, it's there. When you read the lymph edema board you get a feeling for the life-long stress of lymph edema. You kind of have to think about how you feel. Surgeons bill by the procedure, so I wouldn't expect your surgeon to think it's a bad idea. The issue is more whether it is appropriate for you given the amount of DCIS that you have. Rose
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3girls4me Joined: Jul 2007 Posts: 115 |
Apr 27, 2008 11:51 pm
3girls4me wrote:
Hello! I had DCIS which was undetected on the mammogram (caught accidentally on needle biopsy of fibroadenoma). After 2 lumpectomies, I opted for bilateral mastectomy. My surgeon wasn't recommending the SNB for me because my DCIS was low grade. He says he only did SNB for high grade DCIS (comedo) or large areas of DCIS. But he gave me the choice and said he'd do it if I wanted to. I thought about this a lot, was a tough decision. But ultimately, I decided not to do the SNB. Thankfully, there were no surprises in my pathology. No comedo and no invasive cancer was found. The "standard of care" is DCIS areas larger the 5cm or DCIS with comedo necrosis warrants a SNB. But a LOT of surgeons seem to do them routinely with mastectomies. DX 6/12/07 Stage 0, Grade 1 & 2, 0/0 nodes, Bilat Mast w/recon 9/12/07
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PhyllisCC Joined: Nov 2007 Posts: 129 |
Apr 28, 2008 06:07 pm
PhyllisCC wrote:
Hi, I had DCIS also not detected on mammo (I had nipple discharge only). The biopsy found extensive DCIS that was multifocal, and grade 2 and 3. Having a small breast there was really no option but a rt mast. My BS did the SNB in case there may have been a small amount of invasive (there wasn't)...if they even find a tiny bit of invasive after the mast they can no longer do a SNB and must go back in and to take many lymphs to check to see if it has spread. With the SNB, they only took one....and that was clear. I understand that it is a judgement call, but I was glad I had it done. And the pathology from the mast came back with a lot of grade 3 with comedo necrosis. For me, I was glad I was offered the choice. Phyllis |
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Noni Joined: Jan 2008 Posts: 126 |
Apr 28, 2008 08:39 pm, edited Apr 28, 2008 08:40 PM
by Noni
Noni wrote:
I had a bilateral with immediate reconstruction and the breast surgeon did a SNB. The SNB is fairly simple and they might as well do it while they're in there. My surgeon took 3 from each side and thankfully everything was clear. You can mention it to your breast surgeon the next time you speak to him. Actually, it wouldn't hurt to call him tomorrow to just follow up with him about your bilateral mastectomy decision. I made the same choice and don't regret it one bit. bilateral mastectomy with immediate diep on 1/21/08
Dx 12/5/2007, DCIS, <1cm, Stage 0, Grade 3, 0/6 nodes |
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SuperMujer Joined: Mar 2008 Posts: 98 |
Apr 28, 2008 09:04 pm
SuperMujer wrote:
I too had SNB during my mastctomy for DCIS. As it turns out it had miroinvasion of IDC. I would never take DCIS for granted, it is after all a cancer that has not spread outside of the mik ducts in your breast but has very potential to do so. Be aggresive and dont look back!!! Good luck and God bless. LA SuperMujer!
Dx 1/2008, ILC, Stage II, Grade 2, 1/15 nodes, mets, ER-/PR-, HER2- |
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celia088 Joined: Jul 2005 Posts: 2019 |
Apr 28, 2008 09:40 pm
celia088 wrote:
I had DCIS and after 2 lumpectomies with not-clean margins, i had a single mastectomy and asked for an SNB. Once your breasts are gone the SNB cannot be done. Since it is possible (not real likely) to have cancer cells pass thru in the blood, the SNB is a good idea with DCIS to be as sure as possible about being NED. I would definitely recommend the SNB for peace of mind. "May your heart always be joyful, May your song always be sung, May you stay forever young"........Bob Dylan
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cbl Joined: Jun 2006 Posts: 198 |
May 6, 2008 03:36 pm, edited May 6, 2008 03:37 PM
by cbl
cbl wrote:
I had wide spread multi-focal, multi-centric DCIS so having a mastectomy was really my only choice. My surgeon planned on doing the SNB and I didn't question it. I didn't realize that once the mastectomy was done you couldn't go back and do the SNB (my brain didn't fully absorb my diagnosis so I didn't ask a lot of questions) and truthfully I would have probably asked for it if it wasn't already part of the treatment plan. I had a really great breast surgeon. From day one I trusted him to make the best medical, psychological and cosmetic decisions for me and he did. As it turned out I had a tiny microinvasion but no node involvement. I have had no ill effects from the SNB and a lot more peace of mind. |
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