Nodes confusion before or after surgery?
Confused here. I was told that if you went in for Lumpectomy (dcis) but final surgical pathology shows some invasive then you go back for surgery to examine nodes. But, then someone told me, they evaluate the biopsy before surgery to see if you need nodes evaluated during lumpectomy all at one time. (Which makes sense and saves you coming back for another surgery). However, then I read that women's pre-surgery biopsy might not have all the tissue samples to show invasive…..so why would they check nodes during lumpectomy if you don't potentially need it? Then, I thought my surgeon said that biopsies are pretty much of the time accurate to final pathology after surgery?!! So, basically totally confused! What is the 2025 way of doing things with nodes? thx.
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Depending on the study 15 to 30% of tumors classified as DCIS on biopsy pathology are upgraded to Invasive on surgical pathology. Tumors that are larger and higher grade are more likely to be upgraded. My surgeon told me that she was pretty sure that my DCIS was actually invasive and included a SNB in the surgery. She was right: I had a 3.2 cm invasive tumor next to the DCIS. Surgeons can often make an educated guess based on their experience.
Even if a second surgery for SNB needs to be done it is probably the better option. SNB surgery can cause lymphedema and brachial nerve damage so it should not be done unless there is a good reason for it. A second surgery is preferable to dealing with side effects that could have been avoided.
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