How accurate is MRI in showing lymph node involvement?
I have my lumpectomy on Monday and I'm starting to panic about every possible thing. My diagnosis completely blindsided me (as I'm sure was the case for many others!) and I just want to be as mentally prepared as possible for things going forward. I have always hated surprises and now...well.
I had a pre-surgery MRI last week which showed no additional suspicious lesions or areas of concern. The report also said that no cancer was seen in the nodes. However, I have seen numerous stories about people whose nodes appeared normal in imaging but then turned out to be cancerous following surgery/biopsy. How common is this? I have tried Googling this and have found a lot of conflicting information which just made me ever more anxious, so thought I'd ask this wonderful board with its wealth of collective experience.
Thank you for any info you can provide!
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It wasn't accurate for me. Showed no cancer and then I end up with two affected nodes after surgery. But please don't panic. I'm just one example.
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MRIs, like all imaging, only shows things that are above a certain size. A clear MRI is a good sign, but microscopic nodal involvement is still possible. That's why the SNB has to be done.
Hopefully your MRI was right!
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Mine looked clear but I ended up with a micromet in my sentinel node. The only thing it changed was that instead of 22 radiation sessions, I had 33 and with a wider range to include that area. No big deal.
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I had one indeterminate node on mri that was biopsied before my lumpectomy and came back clear. I had two sentinel nodes come back positive - 14 mm and 10 mm so no, it was not accurate for me.
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I had a biopsy of my SN and it was clear and then at surgery that node had a micromet. Stuff happens, but you can't control that so I would try not to waste time worrying the MRI is wrong. Just accept that so far so good and go from there. :-)
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Thank you all for your responses! I have a follow up question, if that's ok.
So what happens when they find cancer in the sentinel nodes? I googled this two and got conflicting information. In some places, it says that you then need a second surgery to check more nodes; in some places, it says that this triggers further testing such as PET scans to see the extent of spread; in other places, it just says nothing. What is most common?
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Hi eviec1!
In the old days, it was common to take out all the rest of the Levels 1 and 2 nodes in a procedure called ALND (Axillary Lymph Node Dissection). However, ALND is associated with lymphedema, and so surgeons now try to take just a few lymph nodes during surgery. Instead of relying on ALND these days, it is more common to increase the area radiated. So, instead of just radiating the breast, the RO also radiates the area where the lymph nodes reside.
I had ALND (20 nodes removed) back in 2015 and have not developed lymphedema. However, as you can see here at BCO.org, some breast cancer patients do develop this condition and have to find ways to cope with it. ((Hugs))
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So if my sentinel nodes do come back positive, the only thing that happens is a little extra radiation? Nothing else? That sounds like good news.
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eviec1,
I would expect that your treatment would depend on how much cancer is in your sentinel nodes. If they're just bursting with cancer, you might end up with ALND. If they just have micromets, I would expect you'd get more radiation. Hope this helps!
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Nodal involvement may also play into the decision on whether or not chemo will be recommended.
eviec1, what is the hormone status and HER2 status of your cancer? That's the starting point for the chemo decision.
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ER+/PR+ and HER -
I also just got my oncotype score - 8. So right now, I don't think chemo is in the plan - just lumpectomy followed by rads. But I guess node involvement could change that plan?
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Being ER+/PR+ and HER2- with a low oncotype score, it would take some pretty big surprises and extensive nodal involvement to push you to chemo. That's not likely to happen. So you're right, chemo is almost certainly not in the plan.
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I guess my fear is that unexpected nodal involvement could essentially send me back to beginning - that, instead of moving forward with the treatment plan, I would be pushed back to additional testing, scanning, surgery, biopsies, pathology reports, etc. Essentially starting all over again with the testing and waiting and worrying. That's what scares me - being sent back to drawing board when all I want to do is move forward.
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My MRI showed clean nodes but then the sentinel node came back with 8mm of cancer. I had an Oncotype of 10.
I still didn't do chemo but I had ovaries removed since I was premenopausal and went on an AI. My plan initially was to just go on Tamoxifen. I also had more extensive radiation to kill any cancer that might be in the remaining lymph nodes.
There was no additional testing or any of that stuff....it was just considering the positive node in the treatment plan.
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My MRI showed no nodal involvement and it was accurate - my sentinel node biopsy also showed no nodal involvement.
How is it that you have oncotype results before your surgery?
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They did the oncotype from the biopsy samples.
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I was going to ask the same thing. It doesn't seem like there would be enough to send out. That's great that you don't have to wait.
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It seems that there was? I mean, I don't really know how it's done or how much is needed, but the breast surgeon sent the sample and told me the result yesterday - so I guess there was enough? They took two samples during biopsy - one was just DCIS, but the other was a good chunk of IDC so I assume that was enough to provide whatever it is they need to analyze. I hope so, anyway!
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I actually had the opposite happen, I had two suspicious nodes identified during my Breast MRI, along with the tumor. The tumor did, in fact end up being IDC. The two suspicious nodes, however, were benign reactive nodes.
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Mine was similar to Salamandra. No nodal involvement seen on MRI which was confirmed by the SNB. I hope your MRI was accurate also
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My nodes looked good in imaging but unfortunately came back positive. One with extra nodal extension. My surgeon had me scheduled for ALND but after meeting with the tumor board she advised radiation would be an option without having the ALND. I chose the radiation and was thankful my implant survived ( I had immediate recon)
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My MRI was clear also. After BMX, 2 sentinal
nodes had micromets (less than 2 mm cancer). I pushed for and wanted ALND (against oncologist and surgeons recommendation) knowing myself and I know I would not be able to function not knowing if further spread. I said I was more suited to deal with lymphadema risk than unknown. After ALND they found two additional fully positive nodes (4 mm of cancer each). My Oncotype was a 3. If I didn't have ALND I would've skipped chemo with the 3. Knowing about the 4 'involved' nodes I then had chemo and radiation and charged my entire treatment plan. Knowledge of my full picture for me was key. Just my personal experience. Best of Luck in your decisions. Not easy.
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Clear MrI.. surgery showed 7 positve nodes...treatment plan changed to add chemo...I think the best thing to do is not worry until it is time to worry....easier said than done, I know
Best Wishes
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My MRI only showed one node lit up (intermammory lymph node - no where near my tumor) so they still decided to remove a few nodes during surgery to be sure. Two others were positive for cancer! I have a hard time trusting imaging!
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MRI missed my positive nodes twice. Blindsided twice after surgery by pathology. I have to see radiation on Monday to see if they will do radiation again, or if it's back to surgery for ALND.
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It is more common for imaging to miss positive nodes if you have ILC, because of the single-file way the cells can spread vs. forming a lump.
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My imaging also showed that my lymph nodes where clear. 3 Lymph nodes appeared normal when surgeon removed them, initial testing during surgery showed they where begnin. But ILC is sneaky so my surgeon and the pathologist didn't rely on this (I think they always do more testing), but further testing showed that all three lymph nodes had cancer. I am now scheduled for auxiliary node dissection on July 12th along with having a port placed for Chemo.
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Pudelpointer,
I’m so sorry to hear this!!! I thought you were going to have the easier road.
I messaged you!
I’m here if you need me.
I hate that those lymph nodes dictate chemo.
Sending lots of hugs your way
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In my situation the mri showed no cancer in lymph nodes. During surgery I had 2 in nodes. My surgeon removed 12 nodes. Just finished radiation treatment 3 weeks ago. Going thru the effects of radiation, wow it’s rough right now
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