Micromets in the first sentinel node after BMX; should I ask for ALND?
I just had BMX three weeks ago. The surgeon took one sentinel node from each side. The pathology report showed the sentinel node on the right side has 0.3mm micromets with no ENE. I asked the surgeon if we should take out additional nodes to check - basically do an ALND; she said “no, I didn’t find any suspicious nodes; basically chemo or radiation or both will be needed and should take care of it. “. I am just wondering if this is the standard protocol now. I understand nowadays doctors don’t want to take more lymph nodes if not necessary to minimize the risk of lymphedema. But I am just worried. My current pathology stage is T1bN1Mi.
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Hi @nuinui724, The protocol for ALND has changed in recent years. What was your tumor hormone profile? If it was ER+ and an Oncotype DX was ordered that would predict the benefit of chemo. If chemo were not recommended then nodal irradiation might be advised. If you are not comfortable with your surgeon’s recommendation you can always get a second opinion. All the best.
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@maggie15 , hi Maggie, my tumor is ER/PR + and HER2+. However， biopsy was Er/PR + and HER2 - (FiSH negative ). However, after surgery, the pathology showed it’s borderline HER2 +. Oncotype score was 20 (ordered before the final pathology report). Is it common to seek 2nd opinion from other surgeons after BMX is done?
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@nuinui724, If you are over 50 chemo would not be recommended for an ER/PR+ tumor with an Oncotype of 20. If the surgical pathology showed the tumor was HER2+ chemo would definitely be recommended but not if it's HER2 low (even borderline 2+.) After a mastectomy radiation is usually recommended only if there is a positive node but micromets don't seem to be counted as positive.
Any time you question the treatment a doctor recommends it is a good idea to seek a second opinion. Otherwise you will forever wonder if you did the correct thing. Good luck getting the answers you need to feel comfortable.
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