No sentinel node were found during sentinel node biopsy

bridget28

Hi, i have a few questions and i wonder if anybody had the same experience.

1. I recently had my Mastectomy done and the doctor performed a sentinel node biopsy for me. However strange enough after the surgery he says that he couldn't find the sentinel node and histopathology report came back with 2 axillary lymph nodes removed however they are not stained with blue dye. This worries me as would this means a non-conclusive of the lymph node involvement as there's so little lymph nodes were being tested and there is still high chance that there are other lymph nodes may be positive.

2. Report also says tumor emboli are found in lymphatic channels but there is no evidence of perineural / venous invasion. Should i be worried of micrometastatis?

3. i had a Nottingham histologic grade 2 with tubular / pleomorphism score 3 but mitopic scare 1. Does this consider an aggressive type?

I was advised for hormonal therapy, but my fear is it could have high recurrence and trying to see what else i need to take care of - or anything i can do.

moderators

Bumping for bridget -- does anyone have any thoughts or experiences to share?

Bridget, sending good thoughts for more info and clarity soon for you!

--The Mods

maggie15

Bridget28, I gather from the terminology that you live in the UK/Ireland. I have lived in both countries as well as Canada but my bc experience has been in the US. Knowing the vocabulary to look up on this site should help you find more information. Of course, the best thing to do is ask your doctor. Bring a calm relative/friend to the appointment to take notes for you since the amount of information can be overwhelming.

1. This seems to happen about 10% of the time, most often to older women, BMI>30 and/or tumor you can't feel. Sometimes radioactive tracer is used instead of or with the blue dye (I had both) so ask about your procedure. If the two lymph nodes were clear and you had no axillary swelling things are probably OK. SLNB does not take many nodes (3 in my case.)

2. This refers to lymphovascular invasion (LVI). This means that tumor cells were found either in the lymphatic channels near the tumor (both your case and mine) and/or blood vessels in the excision area. It's not a positive thing but it did not change my staging or treatment. My surgeon told me that it is evidence that the cancer cells have learned how to spread but that can happen to anyone with an invasive tumor whether or not it is seen.

3. Nottingham histologic grade is the sum of the scores (1 - 3) from the three characteristics mentioned. Yours add to 7 which makes the tumor grade 2, intermediate between grade 1 and grade 3, not the most aggressive.

4. You mention that you will be taking tamoxifen so I assume you are ER+. The two other important factors which influence treatment/prognosis that you didn't mention are whether or not you are HER2 +/- and the tumor size. Did the doctor mention chemo?

5. As far as what else, you can ask the doctor about your stage which depends on the lymph nodes and info mentioned in 4. The oncotype dx, a genomic test which analyzes a piece of your tumor in a lab in California, is sometimes ordered for tumors that fall into specific guidelines to determine whether chemo is beneficial and what the chance of recurrence is 9 years later if you take hormonal therapy. Most US insurances, the NHS and some Irish insurances cover this if appropriate. If your insurance does not cover it you can pay for it yourself but it is expensive (about $5,000.) Daily exercise of at least 30 min, healthy diet and avoiding alcohol have all been shown to be effective at preventing recurrence and are free.

I hope this helps.

bridget28

thanks Maggie. This helps. *hugs

weninwi

maggie15,

What an exquisitely written and thorough explanation for bridget28. I'm gong to save it for the clarity, although I'm long past the disease stage described. I had radioactive tracer injected around the edge of the nipple (interesting procedure) to locate the sentinel nodes, but only one node lit up during lumpectomy surgery, so that's all the surgeon took out. The node was negative and nothing more was considered, although I think they treated the lymph node area when I had radiation. I also like your last words of guidance: "Daily exercise of at least 30 min, healthy diet and avoiding alcohol have all been shown to be effective at preventing recurrence and are free". I have followed this guidance from my initial diagnosis, and although it didn't prevent recurrence for me, I continue to follow it as solid, simple advice. Bridget has been well advised.

Wendy

threetree

I had a large (5-6 cm), stage 3, ER+ tumor in 2018. I had neo adjuvant chemo and then at the time of surgery they removed one sentinel node only and it was clean. The surgeon didn't do additional nodes, largely to save me from more lymphedema risk, but they radiated that area when I got radiation. The surgeon said he thought radiation would take care of anything he might have missed. The oncologist was quite upset that he didn't take more nodes and felt like there was no way to ever know what was really there now. I talked about it with the surgeon and agreed with him, that more than likely it wasn't going to make any real difference in the long run, and I was less "carved up" and less likely to have more lymphedema complications because of his approach. He was an older and very experienced surgeon, who most of the hospital staff went to also, when they needed surgery, so I trusted him far more than my young, inexperienced, but sometimes "full of herself" oncologist.

The cancer did recur in my bones just recently, but I do not think the sentinel node issue had anything to do with it. I think it was because my cancer was described as "locally advanced" at the time of diagnosis, and it may well have been in these chest bones already, but not visible on any scans. (I was determined at the time of surgery to have no node involvement or spread anywhere else, but they assumed those cells were out there, anyway, due to the advanced stage and large tumor size. I was on endocrine therapy (Letrozole) for 3 years, and it still came back.

Bridget - I wouldn't worry too much about them not having found a sentinel node. I also think I would just trust the doctors at this point. There are so many factors that go into all of this (tumor characteristics, your own genetics, lifestyle, etc), that one thing like a "missing" sentinel node is highly unlikely to make or break your ultimate outcome. I'm just so sorry that you have to deal with any of this at all, and I wish you the absolute best of luck with what's ahead.

maggie15

Thank you, Wendy. I have a strange scholastic background (math, English, Latin, science, education) that makes sense to me since all of these subjects involve different modalities of communication people need to be able to transition between. My MO burst into laughter when I drew him a diagram of an auditorium with 100 seats on each side of the aisle to explain my analysis of my personal risk/benefit situation related to AIs. My favorite doctor is my pulmonologist who has a BA in English since he is willing to explain his understanding of my situation in relation to any medical topic.

My husband's unusual job as a geneticist/AgVet biostatistician meant that we lived in many places without the umbrella of the US government so I got to experience the different health systems firsthand. The NHS in the UK was paid for and ahead of the US in drug approval but since provider choice depended on where you live it might be many excellent options or assignment to the sole doctor for that area. Ireland has various categories of free care to faster/better care with progressively higher costs. Canada was paid for and pretty good but timely care was triaged, drug approval is behind the US, and Ontario was better than Quebec. The US has its problems but even though I live in a rural area with limited medical expertise I can travel 100 miles for anything not routine.

The UK has breast cancer websites/forums but they are nowhere near as informative as this one. I'm not mbc but I developed a rare potentially fatal side effect from radiation which makes some of the mbc posts very relevant. I appreciate reading about your experiences and those of others since there is no pigeonhole for me (I'm one of a few oddballs in the pulmonary fibrosis community and there are not many stage 2ers with my concerns.) Without mask mandates I can't do much until I can meet others outside again so this website, despite the tech glitches, is a connection to the outside world.