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Topic: Early stage triple positive node biopsy

Forum: HER2+ (Positive) Breast Cancer —

Testing, treatment, side effects, and more.

Posted on: Nov 30, 2021 06:46AM - edited Nov 30, 2021 06:48AM by Mmcking3

Mmcking3 wrote:

Hi all!

I have surgery coming up on December 6th. Currently am nervous and apprehensive about having my lymph nodes removed. None have shown any cancer on previous screenings. When asked about using an ultrasound guided biopsy to test them my surgeon just said no. I've finished chemo and my primary tumor is undetectable on imaging. So I'm curious of any other ladies refused to have them removed.

I found a page on Sloan Kettering’s website claiming there’s no benefit to women who are having a lumpectomy and rads so I’m torn!
https://www.mskcc.org/cancer-care/types/breast/treatment/lymph-node-biopsy

Dx 7/2020, IDC, Right, 1cm, Stage IA, Grade 3, ER+/PR+, HER2+ Chemotherapy Carboplatin (Paraplatin), Taxotere (docetaxel)
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Nov 30, 2021 08:29AM Beesie wrote:

Are you asking about a Sentinel Node Biopsy or an Axillary Lymph Node Dissection? The article you linked refers to an ALND. As far as I know, everyone with an invasive breast cancer diagnosis has an SNB, although in the past an ALND may have been more routine after neoadjuvant chemo.

But I'm not HER2+ nor did I have neoadjuvant chemo, so hopefully someone else comes by who has that experience.

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
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Nov 30, 2021 08:40AM - edited Nov 30, 2021 08:45AM by Mmcking3

I was referring to the SNB. I think last paragraph on that page refers to having the sentinel nodes removed. And yes it seems like in the past the ALND was the standard of care.

Dx 7/2020, IDC, Right, 1cm, Stage IA, Grade 3, ER+/PR+, HER2+ Chemotherapy Carboplatin (Paraplatin), Taxotere (docetaxel)
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Nov 30, 2021 11:13AM Beesie wrote:

I saw that sentence and it makes no sense in the context of the rest of what the articles says.

"During lumpectomy or mastectomy, we routinely perform what is called a sentinel node biopsy, in which we remove one or more lymph nodes under the arm to inspect for cancer cells. The sentinel node is the first node to which breast cancer cells travel after leaving the breast. We can determine which node or nodes these are by injecting a small amount of dye or radioactivity into the breast and tracking where it goes next.

If the sentinel lymph node or nodes are free of cancer, we'll leave the remaining axillary lymph nodes alone. This approach saves many women from the most troublesome potential side effect of more-extensive surgery: swelling of the arm, known as lymphedema.

For women who have a mastectomy, removing the underarm lymph nodes is necessary if they contain cancer cells. However, research shows that removing the sentinel lymph nodes offers no benefit for women who have had lumpectomy and radiotherapy and who have only one or two sentinel nodes containing cancer."


So they say that they do routinely perform an SNB for patients undergoing a lumpectomy or mastectomy. And to the last sentence, how can they know that only one or two sentinel nodes contain cancer if they have not performed a SNB? (A needle biopsy is not definitive since it only picks up a sample of the nodal tissue, versus having the entire node evaluated under a microscope by the pathologist.) My guess is that it's a typo, and the last sentence is supposed to say "However, research shows that removing the axillary lymph nodes offers no benefit for women who have had lumpectomy and radiotherapy and who have only one or two sentinel nodes containing cancer." This makes sense and there is research that shows that an ALND is not necessary when the SNB finds only 1 or 2 positive nodes.


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
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Nov 30, 2021 11:56AM Mmcking3 wrote:

That would make significantly more sense than it does as is. It added to my confusion needless to say. I found a couple of studies about it but can’t really understand them. I’m definitely not a scientist

Dx 7/2020, IDC, Right, 1cm, Stage IA, Grade 3, ER+/PR+, HER2+ Chemotherapy Carboplatin (Paraplatin), Taxotere (docetaxel)
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Nov 30, 2021 02:03PM gamzu710 wrote:

Definitely ask your surgeon. When mine checked on me in pre-op for my sentinel node biopsy I asked if there was any chance of it turning into an axillary lymph node dissection if they found something and that if so, I didn't want to consent to that part, that I would prefer to talk it through first and then go back in again if we decided it was truly needed because the research I had been reading was unclear. At some point earlier in the staging process the possibility had been mentioned. She reassured me that this wouldn't happen and that it wasn't even on the consent form. I woke up minus only 1 node. This is definitely a concern they should address with you because it's a good question!

Surgery 7/28/2021 Lumpectomy: Right; Lymph node removal: Sentinel Dx 8/3/2021, DCIS/IDC, Right, <1cm, Stage IA, Grade 2, 0/1 nodes, ER+/PR+, HER2+ Chemotherapy 10/20/2021 Taxol (paclitaxel) Targeted Therapy 10/21/2021 Herceptin (trastuzumab)
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Nov 30, 2021 04:46PM Mmcking3 wrote:

thank you gamzu! I can’t remember what all my surgeon discussed with me previously. The chemo brain got me during that appointment!

Did you have any issues healing the node removal? Both of my close cancer friends had issues with their shoulders and I’m a bit concerned

Dx 7/2020, IDC, Right, 1cm, Stage IA, Grade 3, ER+/PR+, HER2+ Chemotherapy Carboplatin (Paraplatin), Taxotere (docetaxel)
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Nov 30, 2021 06:32PM gamzu710 wrote:

I personally found having 1 node removed to be very minor in terms of recovery. I did not have any lingering pain or odd sensations anywhere and it seemed to heal quickly. Port placement was worse. Experiences may vary, though. And I'm a little nervous that only one node was tested, honestly. I read the surgeon's notes in my portal on the operation and the one node was the only one that picked up the tracer, so there wasn't anything else to do, but I was expecting 2-4 sentinel nodes to be removed.

Surgery 7/28/2021 Lumpectomy: Right; Lymph node removal: Sentinel Dx 8/3/2021, DCIS/IDC, Right, <1cm, Stage IA, Grade 2, 0/1 nodes, ER+/PR+, HER2+ Chemotherapy 10/20/2021 Taxol (paclitaxel) Targeted Therapy 10/21/2021 Herceptin (trastuzumab)
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Nov 30, 2021 08:12PM Mmcking3 wrote:

That’s encouraging! My port placement was uncomfortable, felt like my neck was extra tight on that side and sleeping on it was and sometimes still is annoying. I can understand why you’d feel nervous! I can’t do MRI’s which seem to be the gold standard for cancer imaging and it’s always made me uneasy. Maybe they only took the one because you did adjunct chemo too

Dx 7/2020, IDC, Right, 1cm, Stage IA, Grade 3, ER+/PR+, HER2+ Chemotherapy Carboplatin (Paraplatin), Taxotere (docetaxel)

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