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Mar 16, 2013 08:38AM
I wonder if the surgeon is doing an axillary dissection along with your biopsy because either he or the hospital does not have the capability of doing an SNB. The hospital that I was initially going to be treated at was planning to do an ALND on me because they didn't do SNBs at that facility. (This was in the days before SNBs were commonplace). That was enough for me to change hospitals.
I didn't have a chance to reply to your previous answer to me in your other thread, but you said:
"I saw the surgeon the following Monday where he shared the radiologist's report. It read, " results highly suggestive of malignancy...given the mammographic appearance this is likely an invasive lobular carcinoma." The surgeon is doing a lumpectomy and an axillary lymph node dissection. He assured me he would not be removing more than a few lymph nodes, and that occasionally they can have pathology done right there, but typically it takes a few days. Does that make sense?"
Honestly, the answer is "No". "Only removing a few nodes" is the definition of an SNB. If the surgeon is only removing a few nodes without the benefit of doing the full SNB process (i.e. the injections of the dye and/or isotopes), then there is a risk that he may not get the right nodes. An SNB is a very precise and specific operation and the dye or isotopes is a critical part of the process. Without doing the injection, the full first level of nodes, and usually some of the second level, should be removed. That's a lot more nodes. And that's an ALND.
Doing an ALND and not an SNB for any surgery these days, and particularly for a biopsy when cancer hasn't yet been diagnosed, does not make sense. It sounds as though it is highly likely that you will be diagnosed - your image probably is a BIRADs 5 with about a 95% chance of finding cancer. But going into a biopsy, there is always a possibility, maybe just a small one, that cancer won't be found. I've seen a lot of women over the years on this board who've had doctors who were absolutely certain that they had breast cancer, but it turned out that they didn't.
Of course the more likely scenario, given what your surgeon has said, is that you will be diagnosed. But there is no way to know if the cancer is in your nodes, and even if it is, that still doesn't mean that an ALND will be necessary. An ALND is no longer a standard procedure when nodes are found to be positive; the decision on whether to do an ALDN is now part of the overall treatment plan decision that's made once the preliminary diagnosis is in. If chemo is necessary, and particularly if rads will be also be given to the nodes, then an ALND is often not done.
So unfortunately, no, what your surgeon is telling you doesn't not seem to make sense.
Dx 9/15/05, DCIS-MI, 6cm+ Gr3 DCIS w/IDC microinvasion, Stage IA, 0/3 nodes, ER+/PR- “No power so effectually robs the mind of all its powers of acting and reasoning as fear.” Edmund Burke