Lymph node ultrasound?
Hi!
I am new here. I was diagnosed with IDC on 12/21/22. I had an appointment with my surgeon on 1/10 where I learned that my breast cancer is stage 1 and triple positive. I am scheduled for a mastectomy on 2/2 followed by Chemo, possibly radiation, and HER2 therapy.
I'm very comfortable with the doctors I have lined up, but we decided to get a second opinion from a doctor at another hospital system in our area. She basically concurred with the treatment plan I have in place. The only difference is that she said she would do an ultrasound of my lymph nodes. If anything showed up, it's possible they'd recommend chemo prior to surgery.
Do any of you have experience to share or thoughts about this?
I should probably add that I have an MRI scheduled for next week and we are also waiting on genetic testing results.
Thanks in advance for any insight you can share!
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Hi ruby216, When I had my ultrasound guided biopsy after a suspicious mammogram that showed calcifications but no lump the radiologist immediately saw a tumor he didn't like the look of. Before he biopsied it he used the ultrasound wand to check my lymph nodes. He didn't see any suspicious nodes and told me he would have done a needle biopsy if he had. After surgery the sentinel lymph node biopsy showed micromets in one node so the ultrasound doesn't really replace pathology. Neoadjuvant chemo would not have been recommended in my case since there was no extensive nodal spread or a breast tumor that had to be shrunk.
Is your MRI going to include the lymph nodes? It will certainly check for any occult tumors and give the surgeon a better read on your situation. Do you have any axillary swelling? The reason for assessing suspicious lymph nodes before surgery is so that an axillary clearance can be scheduled during surgery to avoid a second operation. I'd recommend contacting your surgeon to ask whether they think the ultrasound is necessary. Since you are having a mastectomy you will have a SLNB to check the nodes anyway.
It looks like you are on top of things and have a good team lined up. Best wishes going forward with your treatment!
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Hi Ruby216,
Thanks for posting - we're sure others will be by shortly to weigh in with their thoughts and experience. In the meantime, we wanted to point you to this study from the Breastcancer.org Research News on Lymph Node Ultrasound Before Surgery Can Help Find Cancer Spread (it's a little old - 2009 - but it gives you some insight on the thoughts behind this type of diagnostic testing).
We hope this helps and thanks again for posting!
--The Mods
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When I was diagnosed last spring, they did a lymph node ultrasound at the same time as the breast ultrasound. One lymph node was enlarged and suspected to be cancerous. They did a biopsy a few days later and it was benign; subsequent removal at surgery confirmed the benign result. I am also triple positive.
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I had MRI before surgery that showed my lymph nodes were negative but the pathology after surgery found 2 positive nodes. Ultrasound is non-invasive, I would do it even if not acurate but to have some kind of idea.
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I feel the reason a lymph node ultrasound would be recommended is being driven by the Her2+ aspect of your diagnosis. There is a division in the treatment approach for Her2+ patients between stage 1 and stage 2 - which is what you would potentially be if lymph node metastasis was found. Stage 1 Her2+ patients can receive surgery first with single agent chemo (Taxol) and Herceptin to follow. If your diagnosis becomes more complex, there is greater potential for additional anti-Her2+ meds to be added, likely Perjeta, and your chemo regimen could also change to a multi agent type. Perjeta was initially offered to early stage patients starting in 2013 and was only FDA approved for neoadjuvent chemo so that effectiveness could be tracked. This order - chemo, then surgery, then rads if needed - has remained the standard of care since that time for those with stage 2-3 Her2+ cancers. This is an important determination to be made since it does have an effect on how your treatment should be tailored, so even though it adds a new layer of stress or delay, it does provide information and a path to the most efficacious treatment for you. Wishing you the best - hang in there!
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Thanks so much for your replies. My surgeon's office called me back about the lymph node ultrasound and said it wasn't necessary because they'll test my sentinal node during surgery. I have an MRI coming up next week. Should I push for getting the ultrasound? What is the advantage of chemo prior to surgery?
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Because you are already scheduled for the MRI, I would think the US on the axilla is not necessary - the MRI should encompass the area and give a visual. Generally, MRI would be considered a more sophisticated/accurate imaging tool than US. The advantage of chemo prior to surgery is that it affords the opportunity to see whether it is working to shrink or eliminate the cancer. If you have surgery first you have to take on faith that chemo and targeted therapy is effective because the thing you measure against has been removed. That said - the goal of neoadjuvent chemo is not really to eliminate the tumor in the breast - that is what surgery is for - it is to eliminate cancer cells that have left the breast and keep them from setting up shop elsewhere in the body. Lymph node involvement means a higher stage cancer and warrants a possible change in the choice of drugs - multi agent chemo and the addition of Perjeta to Herceptin - from a typical stage 1 choice. Perjeta is given neoadjuvently - and sometimes continued adjuvently as well - so that would be why the order might be changed.
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Wow, SpecialK - you are really good at explaining this complicated stuff. I'm starting to realize that my brain kind of shorts out when I'm talking to my doctors and I'm not fully comprehending everything. There's so much new terminology to learn and I still can't even believe that I'm going through this when I feel perfectly fine!!! Your straightforward explanation really helps. Thanks for taking the time to write back to me!
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ruby - you are not alone in having difficulty processing the steep learning curve that comes at the beginning of treatment! We have all been there! I have the advantage of time to have absorbed some of this! Please do not hesitate to ask questions - if you are like most of us, you think of what you wanted to ask right after you leave the doc's office! Or, in the middle of the night! There are also folks on the Triple Positive thread - linked below - who have lots of experience and can hopefully address questions you might have, or ask them here! The silver lining in this crappy experience, for me, is the ability to help folks like you who are new to this club nobody wants to be in. Hang in there!
https://community.breastcancer.org/forum/80/topics/764183?page=4005#idx_40045
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Ruby, After my friend’s experience I went with all the scans and ultrasounds offered. My friend was stage 1 had a double mastectomy first then chemo…six she years later she was diagnosed with bone Mets. After, becoming stage IV…shehad all of her original scans reviewed by the big hospital in Houston and sure enough it was in her lymph nodes when she was first diagnosed and was missed. This is not a disease to mess around with and I think it’s best to throw everything at it your first go around.
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