AND after negative SNB?

yogamommy

Hi everyone.
I had a SNB done before chemo and the 3 nodes taken out came back clean. I am finishing up 5 months of neo-adjuvant chemo and getting ready for surgery (bilateral mx).

My question -- is there any benefit to having more nodes taken out -- such as an axillary node dissection or even a node sampling?

Thank you so much

concernedsis

Hi Vickie - thats obviously a question for your specific onc. My sister's doc did a sentinel node and the 3 nodes were clear in the OR and on the final path report. Surgeon however said the nodes looked abnormal (negative on exam, mammo, sono, MRI, PET) and she did a level 1,2 axillary dissection and over 1/2 were +. At her radonc appt the doc said the sentinel node is not always clear in large tumors which was never said to her b4. There is certainly a risk of lymphedema after axillary node dissection so that needs to factor in. There are some studies on something called PARP inhibitors for triple negative but not sure if widely available or only trials. Good luck to you.

yogamommy

Thank you very much.

What did they mean -- the SN is not always "clear" in large tumors?  Meaning the results are not accurate?

I WANT to believe so much that my nodes are clean, but there's part of me, esp. with TNBC, that feels like I just want them OUT of me.

Thanks again.

unklezwifeonty

Dear Vickie,

You are right to think of treating TNBC aggressively.

Talk to your oncologist and surgeon about the possibility of axilla dissection. I think node sampling is not gonna be very helpful because the neoadjuvant chemo could have cleaned them up. By the way, SNLB is considered 95% accurate in correctly assessing lymphatic spread.

I read somewhere that when surgeons learn SNLB, they are supposed to do 20-30 "make believe SNLB", i.e. do SNLB, get frozen section checked for cancer and also do axillary node dissection and get that and the SNL tested on permanent section. They are certified for SNLB once they achieve >95% accuracy and are satisfied that SNLB is reliable in predicting axillary node involvement.

CarynRose

YES!!  Have the other lymph nodes removed and checked.  My SNB was 'clear', but evidently, I had a micromet in another lymph node.  If I'd had a true node dissection, my doctors told me that I would not have had a metastatic recurrence.

Best of luck,

Caryn

concernedsis

As I understand it - a sentinel node is supposed to be the node or nodes that 1st take up the dye from the tumor - meaning cancer if spread would likely spread there 1st. The doctor said that sometimes in larger tumors the sentinel node is not clear - I guess since it is large - other nodes may be involved too in the drainage of lymph from the tumor. In her case sentinel node x 3 negative in the OR and final report but over 70% of the nodes they removed in the dissection b/c they looked abnormal were +.  So sentinel node probably very reliable for most people but not all.