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Topic: Sentinel Lymph Node and Axillary Lymph Node Biopsy

Forum: Surgery - Before, During, and After — Surgical options and helpful tips for recovery and side effects.

Posted on: Aug 22, 2021 02:13PM

macdebbie wrote:

So many questions still....

I met with my BCS for the first time on Monday. She was great and I loved her. She spent a lot of time going over things and answering all my questions. I have a pre-op visit scheduled for 8/30 and my surgery scheduled for 9/14. I need to decided something about the node biopsy when I meet on 8/30 -

She told me that when she does the sentinel node biopsy, I have the option of having her remove axillary nodes (if needed) then and there or coming back and having her do it. She said they do a "frozen" section at the time of surgery.

I'm a bit confused by what she means and how she knows she would need to remove axillary nodes. Would it be better to have it done right then and there?

I have also read (Dr. Susan Love's book) that more surgery is not better and that lymph nodes can be irradiated. I think she said studies were done that showed that option had the same or better result as surgery. Does radiating them cause the same potential side effect of lymphedema? I also read that they lymph nodes can be ultrasound imaged to see if they have cancer. Wouldn't that be better than removing them?

In the book she mentions an "advanced" technique to lower the risk of lymphedema where a different color dye is used to define the breast lymph nodes vs the arm lymph nodes. Has anyone had that done? My surgeon said she doesn't even use dye, just the tracer.


Dx 7/29/2021, IDC, Right, <1cm, Grade 2, ER+/PR+, HER2- (IHC) Surgery 9/13/2021 Lumpectomy: Right; Lymph node removal: Sentinel Hormonal Therapy
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Aug 22, 2021 02:46PM exbrnxgrl wrote:

When the sentinel node/nodes are removed during surgery they are immediately evaluated, under a microscope not by imaging, for cancer cells. If they are positive for cancer cells, many surgeons will do an axillary node dissection while you are already in surgery. Some will wait and do it afterwards, which then becomes a separate procedure. More surgery is not better in terms of increasing lymphedema risk, but if cancer is found in the sentinel node there is a possibility it has gone to other nodes. I am not familiar with Dr. Love’s book but radiation by itself or even surgery by itself can cause lymphedema. I had rads to a bone met on my femur and have mild lymphedema in my leg. Ultrasound imaging can only detect cancer in the nodes if it has grown large enough to be detectable. None of my pre-surgery imaging indicated any cancer in my nodes yet when examined after surgical removal, there it was!
i think, because I read your other thread, that you need to understand that there can be breast cancer cells in your body that are too small to be detected by any means we currently have available. That is why radiation and/or other treatments may be recommended for early stage bc. It helps clean up what can not yet be detected. Most estimates are that breast cancers may have been growing for 5-10 years before they are detectable by any type of screening or assessment. So although this may not be comforting, it is simply not possible to find and eradicate bc cells until they have grown to a certain point. Take care.

Bilateral mx 9/7/11 with one step ns reconstruction. As of 11/21/11, 2cm met to upper left femur Dx 7/8/2011, IDC, Left, 4cm, Grade 1, 1/15 nodes, mets, ER+/PR+, HER2- Surgery 9/7/2011 Lymph node removal: Left; Mastectomy: Left, Right; Reconstruction (left); Reconstruction (right) Dx 11/2011, IDC, Left, 4cm, Stage IV, Grade 1, 1/15 nodes, mets, ER+/PR+, HER2- Hormonal Therapy 11/21/2011 Arimidex (anastrozole) Radiation Therapy 11/21/2011 Bone Hormonal Therapy 6/19/2014 Femara (letrozole) Hormonal Therapy Aromasin (exemestane)
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Sep 7, 2021 10:04AM Jewelweed wrote:

I am replying to this so I can follow. My surgery is coming up on Thursday, and the sentinel node biopsy is the part that I am most nervous about. I swear, I will be levitating with joy in the recovery room if my node tests negative!

In my biopsy, the one that found I had a 5mm tumor in my left breast, the pathology report said that it was "negative for angiolymphatic involvement," which I interpret as "so far so good." I hope thos bodes well, but I know that this is not the final word. Sigh.

Dx 7/15/2021, DCIS, Left, 5cm, Stage 0, Grade 2, 0/3 nodes, ER+/PR+, HER2-
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Sep 7, 2021 03:10PM macdebbie wrote:

Jewelweed, best of luck Thurs. Fingers crossed for good news for you!

Dx 7/29/2021, IDC, Right, <1cm, Grade 2, ER+/PR+, HER2- (IHC) Surgery 9/13/2021 Lumpectomy: Right; Lymph node removal: Sentinel Hormonal Therapy
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Sep 7, 2021 10:11PM - edited Sep 7, 2021 10:17PM by Aklynna

Hello!

I had a lumpectomy + sentinel node biopsy on 8/26. At my post op last week I got a copy of the pathology that shows “negative for malignancy" (yay!!!) in 2 sentinel nodes and 1 axillary. I'm not sure what exactly prompted her to take that 1 axillary. I don't recall her mentioning that at the pre op appt, but I may have just missed it with everything else.
Also, sounds like we have almost identical diagnoses, except mine is on the left :

Good luck to you!

Kristy Dx 7/15/2021, IDC, Left, <1cm, Stage IA, Grade 1, 0/3 nodes, ER+/PR+, HER2- Surgery 8/25/2021 Lumpectomy: Left; Lymph node removal: Sentinel, Underarm/Axillary
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Sep 7, 2021 11:07PM MarvieS wrote:

Aklynna - Wonderful news about the negative lymph nodes. Very happy for you! I have my post op appointment next week and am anxious about the results. Has your doctor mentioned anything about oncotype testing or do you already know what treatment will be next?

Jewelweed - Best wishes for your upcoming surgery!

DX at 48. IDC 7mm. Onco 25. Dx 7/16/2021, IDC, Right, <1cm, Stage IA, Grade 3, 0/3 nodes, ER+/PR+, HER2- (FISH) Surgery 9/3/2021 Lumpectomy: Right; Lymph node removal: Sentinel Radiation Therapy 10/8/2021
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Sep 8, 2021 06:51AM Aklynna wrote:

Marvie- my tumor was too small to have the Oncotype test done. It must be OVER 5 mm and mine is just barely 5. Radiation will be next. I have a consult for that on 9/29. Good luck at your post op!! Removing some of the bandages was not a super pleasant experience.

Kristy Dx 7/15/2021, IDC, Left, <1cm, Stage IA, Grade 1, 0/3 nodes, ER+/PR+, HER2- Surgery 8/25/2021 Lumpectomy: Left; Lymph node removal: Sentinel, Underarm/Axillary
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Sep 15, 2021 11:48AM Jewelweed wrote:

I am so happy for you! I had surgery on Thursday and am impatiently waiting for the pathology report.

Dx 7/15/2021, DCIS, Left, 5cm, Stage 0, Grade 2, 0/3 nodes, ER+/PR+, HER2-
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Sep 18, 2021 03:26PM Jewelweed wrote:

I just got the pathology report! My lymph nodes tested negative! I am weeping with joy!

Haven't talked to my doctor yet-- the report was released end of day Friday-- but this is very welcome news. I was so anxious about this!

Negative! Negative!

Dx 7/15/2021, DCIS, Left, 5cm, Stage 0, Grade 2, 0/3 nodes, ER+/PR+, HER2-
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Sep 18, 2021 03:41PM PamEP wrote:

I was also so nervous about my pathology report after lumpectomy with SLNB that I had to have my partner drive me to the appointment with my BC surgeon. My blood pressure was through the roof! I totally understand your relief. With you I was so relieved to get a negative on lymph nodes! I also want to point out that my excisional biopsy noted lymphovascular invasion, which is what really caused my fright at the path report. So that presence doesn't mean you necessarily have positive nodes.


Dx 7/26/2021, DCIS/IDC: Cribriform, Right, 1cm, Stage IA, Grade 1, 0/4 nodes, ER+/PR+, HER2- (IHC) Surgery 8/6/2021 Lumpectomy: Right; Lymph node removal: Sentinel Hormonal Therapy 10/15/2021 Tamoxifen pills (Nolvadex, Apo-Tamox, Tamofen, Tamone)

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