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Apr 13, 2020 10:43PM
bbbddd168, I'll comment only on the sentinel node biopsy question and why only one node was removed.
What your surgeon said is correct. The nodes are grouped together in an unorderly way and visually a surgeon would not know which nodes to remove. This is why the SNB procedure starts with blue dye and/or isotopes being injected into the breast. The blue dye/isotopes travel through the breast into the nodes. Whichever nodes are "lit up" by the dye/isotopes are the nodes that would most likely be the first to receive cancer cells from the breast, if any cancer cells moved into the nodes. So the surgeon then removes the nodes that lit up with the dye/isotopes. Some people have just one sentinel node, i.e. the dye/isoptopes spread into only one node. Other people have more; most often 2 or 3 but sometimes as many as 5 nodes will be lit up by the dye/isotopes.
Because the surgeon can't see visually if a node has cancer cells (nor can MRI or ultrasound imaging if the nodal involvement is small), the dye/isotope injection is the only guide the surgeon has as to which nodes and how many nodes to remove. The issue therefore is what happens afterwards. In the past, if a patient was found to have positive sentinel nodes, they would go back for a second surgery for an axillary lymph node dissection (ALND), which involves removal of all level I and II nodes. We all have a different number of nodes so the number of nodes removed during an ALND could be as few as 10 nodes or as many as 40, although usually it's about 15-20. These days, in cases where there is only a small amount of nodal involvement (few nodes or micromets), rather than do an ALND, usually rads to the underarm will be done instead. This is based on research that showed no difference in recurrence and survival rates.
So the net of is that in your case only one node was removed because you only had one sentinel node, i.e. one node that lit up with the blue dye.
Dx 9/15/2005 Right, 7cm+, DCIS-Mi, Stage IA, Gr 3, 0/3 nodes, ER+/PR- ** Dx 01/16/2019 Left, 8mm, IDC, Stage IA, Gr 2, 0/3 nodes, ER+/PR-, HER2- (FISH) ** Surgery 11/30/2005 MX Right, 03/06/2019 MX Left ** Hormonal Therapy 05/2019 Letrozole