anyone know about pathology staining for sentinel nodes?

voicewriter

So I had a bilateral mastectomy, the pathology came back all clear, good to go.  Got a second opinion, which basically said the same thing.  I shoud be thrilled, right?  But I analyze everything, and the second pathology report mentioned 9 H&E levels reviewed for the sentinel node.  So I wondered what H&E was, went online, found out it referred to the standard staining that they do, but also saw a lot of info about IHC (cytokeratin immunohistochemical) staining that some hospitals do, which is more sensitive than the H&E, and that sometimes it shows micrometastic disease in the sentinel node that doesn't show up with the H&E staining.  There seems to be a lot of controversy about this, saying the IHC isn't necessarily recommended, because it can show cells that were misplaced, and often isn't true metastasis.  The two hospitals that I've seen here in Boston, Beth Israel and Dana Farber, don't do the IHC staining unless they have a reason to.  My oncologist concurred as well as the pathologist that I spoke with who read my slides.  She said even if they found something if they did the IHC, it wouldn't change my treatment (which is no treatment), and that if it was her, she would just let it go, and consider herself to be node-negative.  I saw something on Susan Love's website about a woman that had a negative H&E and a positive IHC, and she basically said the same thing as the pathologist, go with the fact that you're node-negative. Has anyone had any experience with this or any knowledge about it?  I'm trying to get an appointment with my oncologist to maybe sit down and discuss this with him, who already told me not to worry about it, and I feel like I'm being a royal pain, and I should just be happy with the results and move on with my life.  Anybody have any thoughts?? 

garc403

"The two hospitals that I've seen here in Boston, Beth Israel and Dana Farber, don't do the IHC staining unless they have a reason to."

To me, this is crucial. What would the reason be for IHC? if it is t oconfirm positively or negatively what was seen with H&E staining, seems IHC would be done from the start. I would like to know what circumstances would motivate IHC staining. Fetch that info and get back to us!!

agada

I know Florida Hospital is going to eventually stop IHC staining because it can show cells that were displaced during surgery and this can lead to anxiety in the patient thinking they have mets. My oncologist said it was not a necessary stain.

Agada

ScienceGirl

Hello,

HE staining is what has historically defined 'positive' nodes.  This is what all the studies have used and is what all the treatment decisions / recurrence rates have been gauged by so there is a large body of evidence with this stain.  IHC is newer and more sensitive.  It's just not known if the HE is negative and the IHC is positive what significance that holds.  The oncs I have talked to seem to  lean toward the 'cells dislodged during surgery' camp.   I know that Memorial Sloan Kettering does not use the IHC stain, because it doesn't give meaningful information, just confusion, and from the other posts it seems like other well renowned centers aren't using it either.  I'm sure in the future we will know what it all means, but it will take many years and lots of studies.

I am HE negative, but IHC positive in <2mm in a couple of my nodes.  At first I was panicked, but now I accept that I'm node negative.

Talk to your ONC, several times if needed.  You need to feel comfortable with your treatment plan.

good luck!

Chocolaterocks

Scotchgirl

I should read your post everyday to control my worry.

thanks,

Chocolate

Louisa2

Hello.  I am undergoing a unilateral MX with immediate reconstruction in a few weeks.  I had DCIS treated with a lumpectomy but had very close margins and high grade.  They are going to do a sentinal node biopsy. 

When you ladies talk about "cells displaced during surgery," that makes me think that cancer cells will be "getting loose" in my body or into my lymph nodes, and that sounds really scary.  My doctor has not mentioned this cell displacement to me.  This might be a dumb question, but can cancer metastesize this way?  I was also worried about the fluid buildup after my lumpectomy (didn't have a drain) and the possibility that it could "slosh around" and pick up any cancer cells that might be lurking.   Somewhere on one of the topics a woman said that 3 doctors told her that even with an MX, they can never be quite sure that they're getting ALL the breast tissue. 

Am I being paranoid?