Sentinel Node Biopsy

lisa1313

I have to have Sentinel Node Biopsy done before surgery and wondering if anyone out there has had this and can let me know how painful it is.  She said they will inject nuclear dye into the breast before surgery and then she will remove the node that is first?  then proceed with the mastectomy.

If anyone could share this with me, little nervous of this procedure.  Where do they inject the dye and is there more mams or ultra sound ??? the surgery is 3 hours later

edwards750

lisa...I had one before my lumpectomy. A friend told me she had one and it was painful. It was for me too but remember not everyone is the same with pain tolerance and it doesnt last that long anyway.  Actually I have experienced more discomfort since it was removed and I am sure it is at least in part because of where it is located. It gets better every day so it just has to heal and frankly I am not a patient person. Once they did the SN biopsy and the lumpectomy I was done. I didnt have anymore mams or ultrasounds. You are having a mastectomy so they may do things differently for you. Regardless, you will be okay. You can handle it. Post and let us know how everything went. Good luck...praying for you....diane

listmaker

lisa: I like you checked on these boards before my Sentinel Node Biopsy because my BS, who is a good friend, did not tell me anything about it. The dye is injected directly into the nipple and many on this board have talked about the pain. I had my BS order numbing cream that was put on hevily over my nipple as soon as I had changed into my gown then they covered it with the clear adhesive. It may have been lidocaine but what ever it does take maybe an hour to take effect which is about how long it takes you to get IV's going and everything pre-op in the room. I also asked for a valium or similar just to calm me which I wish I had taken at home before leaving to help with nerves. Then they took me to the Mammo room to put in my needle locator as I was having a lumpectomy and that was not bad at all. Then they sat me back down in the wheelchair and the mammo tech held my hand and the radiologist and assistant gave me the Sentinel Node shot. I was numb by then and honestly it hurt a little but on a scale of 1-10 I think I gave them a 4. It was over quickly and they were wonderful at talking me through it. After the shot I was taken back up to pre-op to let the dye run it's course. I don't remember how long after that because the drugs kicked in. It really did help me knowing what was going to happen before I went in. Best of luck to you, {{{{Hugs}}}} Susan

Plils

Hi Lisa1313,

I am newly diagnosed and had the Sentinel Node Biopsy mapping.  I know a lot of people have had a lot of pain with the injection's,  I had the mapping done first the day before my lumpectomy and then when I was in surgery she did the blue dye.  I night before surgery I had to have to have 3 injection into my breast with the necular stuff and to tell you the truth the first one I did not feel and the 3rd one just felt like a bee sting then after the last injection It stung for just a minute and I could feel it going where it was suppose to other then that It was no big deal hang in there like you said everyone is different.  I had my surgery on 4/7 and she took 6 lymph nodes all neg thank god.,.... anyway I am not waiting for my Oncotype to come back to see if I have to have Cemo or just radiation and Temoxifen.  The only problem I am having with the lymph removal is that I have had to have  it asprated where she went in under my arm a couple of times, I don't know if they will end up putting a drain in or not, we will see.  Good luck and hang in there this is a very scary situation and I am scared to death but it helps to have people going through it with you... I am here for you.

Plils

Hi Listmaker, 

when you had your lumpectomy and Sentinel Node Biopsy how many lymph nodes did they tak and did you have any problems with sermone fluid build up under your are where they took them out at??

CandDsMom

Hi Lisa-

I had SNB too. The injection felt like a bee sting. Pretty painful to happen right at your nipple. The good news was that it went away pretty quickly. I wasn't offered any numbing cream though. Hopefully you will be or maybe ask for it? (((hugs))) 

listmaker

Plils: They took 2 nodes only and I did not have any problems. 1 Node was very deep and she said she had to "dig" to get it out. The worst problem I had was a reaction or something to the adhesive in the dressing, I had a raw kind of rash for a few weeks after but no fluid build up.

listmaker

Lisa: Just a note, the numbing cream does not numb you all the way like Novocaine for a tooth. It numbs the outermost skin layers and partially inner layer. Just didn't want you to expect the dentist kind of numbing. It helps a lot though.

Emaline

Don't they sell numbing lotions? I know a lot of ladies buy it to use prior to getting waxing done.  I will have to look into that.  This is why I am so thankful for this board.  I had no idea about any of this. All I was told is that I was getting the SNB done and would have to come to hospital day before to get nuclear material injection. 

cycle-path

Lisa: as I think some others have explained, they will inject some dye into your breast prior to surgery. I had two injections, one above the nipple and one below. I didn't find them particularly painful. Like a bee sting, as some of the posters reported. Not enjoyable, but not terrible. Not as bad, for example, as when they insert the cannula to start an IV! That's the part I always dread. 

Then you will go into surgery and remove one or more sentinel nodes before the MX. You'll be asleep for the whole procedure.

I didn't find the area of the sentinel node removal to be particularly painful after the surgery, but I guess some women do have trouble with it. My recommendation is not to worry about it. It's pretty minor compared to the rest of what you're having done. 

susanlouise

Hi - it looks like we all have had slightlly different procedures so here's my experience! (from march). Surgery was scheduled for noon.

 I had to go to radiology first to get the node "mapped" - at 8 am. This involved an injection in the breast of some radioactive (I think?) substance, and then some kind of scan at intervals until the radioactive stuff showed up in the lymph node. Then she marked the node on my skin with a sharpie pen and sent me back to pre-op.(I think all this was mostly to show the surgeon where to cut to get at that sentinel node.) The injection was painful, but they didn't have to scrape me off the ceiling or anything - and the pain was brief. Then it just takes some time before the radioactivity shows up in the node - they advised me to  be as active as possible while waiting, so I was walking up and down the hall swinging my arm - and sure enough, in the first scan, the node lit up, so it didn't take very long, relatively speaking.

During the surgery, the surgeon injected dye (after I was asleep), using the mark that radiology had done, and they waited until the node turned blue, and then she removed that node and a few others.

After surgery, the incision for the SNB was a bit tender and it got swollen - kind of like a roll of quarters under my skin for a few weeks! Ice helped a lot. 

sunshinegal

I have to be honest, the injections of the nuclear stuff for the SNB were the worst pain I have ever experienced. I was not offered numbing cream, but unlike other ladies on here who also went without, for me the pain was about 50x worse than a bee sting. I don't know why as I otherwise have a pretty high pain threshold, but there you have it. I would insist on numbing cream if I were you. Good luck!!!

sundermom

I think each BS does this procedure a little bit differently.  I received the nuclear tracer injection before surgery.  I felt a pinch and a very slight sting.  It was mixed with lidocaine.  My BS injected the blue dye after I was asleep because in her words, "It stings like an SOB".  Thankfully, I was asleep so I have no idea!!! Don't be afraid to ask for a little something to help you relax before the procedure.  We've got enough crap we're dealing with and shouldn't have to worry about painful procedures IMO.

Tammy

Bonnygg

My SNB was part of the surgery to put in my port, no mx. I had four shots into the lumpectomy cavity. I did have the numbing cream and pre-op valium. The individual shots only lasted as ong as I could let out my breath with the last one hurting the worst. Then once the shots were done. I had to sit in a recliner for an hour. Then my BS checked to make sure he could see that the dye had moved to the nodes.

After that, I was off to surgery to remove the nodes and have my port put in. The port was for my chemo.

They removed four nodes. But come to find out under the microscope, one of the nodes was actuall 3 smaller nodes that looked like one bigger node. So all total, they removed 7 nodes.

It's been 6+ years since then. When ever anyone wants to draw blood, I have them use the non-snb arm just as a precaution. But I just had my double bmx + DIEP and I let them use my SNB arm. Didn't have much choice. But all the DR's said it was ok to use the SNB arm since it had been so long.

I protected the SNB arm whenever I could from needles & had no problem with any swelling.

So when they want to inject the dye, take a big breath & let it out slowly and the injection will be done.

Normally, but not always, the BS use SNB to help with the decisions regarding the use/type of chemo and staging. Staging helps everyone figure out what treatments and/or how agressive those treatments need to be. Those of us that get the opportunity to do SNB are lucky.

Hang in there & good luck.

bonny

Laurie08

I also have a high threshold for pain and will say it did hurt.  I was nervous about it as you are, I don't remember that they injected it into my nipple, more my breast.  But I has taken a couple of Valiums before heading to the hospital for surgery.  It is nothing you can't endure, it's not something that made me scream out in pain. Did it suck?  Yes.  A big fat tear rolled down my cheek.  But soon after they gave me more drugs to help relax me and I don't even think of it now.  It's nothing that stands out to me from the day I had my BMX.  To me that says it all, it is a moment of discomfort that you will handle and then it will be in the past.

I am not saying this to be cold or simplify things just to let you know it is fast and fleeting, it might be bad, it might not, it's different for all of us.  But you can do it!  Just as child birth is painful we get through it, and that lasts much longer!  Yet most of us will do it again!  This is something you will only have to do once and is much faster and no where near as painful.  I hope this makes sense to you.

Good luck to you and I send you a big hug. 

agada

Hello,

My lymph removal was part of my surgery.  The injections are right in the nipple area.  I did not think they were too bad, just lie still and breath normally and it will not be so bad.  The lymph node removal bothered me most after the surgery, but the pain does go. Pain pills do help.  Your Dr. might give you a few, you might have to ask him/her for them.  Tylenol helped as well.  Don't worry, the injections will be over before you know it.

Agada

cmesker

I had a lumpectomy and snb on April 14 and my experience was almost identicle to listmaker's post (perhaps because we are both in Ky?   )  I had the numbing cream and the shots didn't really hurt much at all, just a little sting.  The most of my complaints came during recovery due to the location of the snb, as that has been really sore.  I'm just now getting to the point that it's not constantly bothering me.  The other thing that bothers me now is where they did the dye injection for the snb. The injections didn't hurt at the time, but I'm pretty sensitive now and just the fabric of my bra is irritating. Hoping that calms down soon.  It isn't as much painful as it is annoying though. The lumpectomy incision isn't noticable at all to me, pain wise.  Good luck, Lisa!

juliet62

i had my snb today, prescribed emla cream,   had 4 injections around the nipple, felt alittle burning when he injected the 4th time, but other than that  felt NOTHING,    took about 20 mins for the first node to light up    was in nuclear med for an hour then to pre op,   home now with my pack of peas insitu,,hope yours goes well

Nana60

I am curious about the SNB. I had one when I had my MX in Aug 2010. When I expressed my concern about the pain of this procedure to my BS - she said not to worry that they perform it during surgery. I am confused why I didn't have the same procedure that is described in this thread. Anyone else not get the dye injected before surgery?

duckyb1

Hi ladies.........I had my SNB, and got only 2 injections, and they were nothing to even talk about, no worse then getting a vaccine shot.............now here is the bitch of it all

After the dye shots, they massaged the breast to get the dye to the nodes where it had to go.......I have no idea why they didn't wait for it to get there......I'm a patient person, and would rather have done that, then have the "gorilla" who massaged my breast kill me..........It was horrible, and I mean horrible.........If I could have got my hands around her fat neck I would have choked her till her eyes popped out.........Not sure if anyone else had the "massage", but i did, and it is awful..................Good luck, and if you don't get the massage, it is really not bad at all......Honestly.............

Emaline

I was told that often the shots have a numbing agent in them?  Maybe that is why it burns when they first inject?

duckyb1

the first one of mine did, the second was the dye

dolphins0412

My dr. did mine while I was under.  I didn't feel a thing.  I did however have some itching the next couple of days at the injection site.

SuziePA

I just spoke to my BS yesterday.  I will also have an SNB prior to my mastectomy in 12 days.  He plans on taking two nodes and as Nana 60 above was advised, he told me I won't feel anything, as he will do it during surgery.  My surgery is at UPENN, if that makes a difference.

dogsandjogs

I had 2 procedures a few hours before the lumpectomy. The first one was the placing of a wire in the lump area - it wasn't bad at all. Then an hour or so later they did the dye injection and that didn't hurt at all. Then I was told to massage the breast for 3 minutes every 15 minutes so the dye would be distributed. So I did that until I was called in to get ready for the surgery.

 It felt very weird to sit in the hospital waiting room and massaging my breast in front of everyone. But all the people there were having various surgeries that day and I don't think anyone even noticed.

I did not have any discomfort afterwards in the sentinel node area. Luckily there was only one sentinel node. I had been told there sometimes were more than one!

Emaline

Okay dumb question but how do they decide on how many to take? Why on some signature do I see 0/1  or 0/14. I know the 0 is positive cancer nodes found and the last number is the number taken...but why in some do the doctors only take 1 and in some, they take 14?  Heck at the group I was at, on someone they took over 20 and almost all of them were positive.

I'm confused here....

Beesie

Emaline, first it depends on how many nodes "light up" from the dye and/or isotopes.  If the dye goes to more than one node, the surgeon will usually remove all the nodes that the dye/isotopes flowed to.  And even if the dye only goes to one node, just to be on the safe side some surgeons will also remove the node that is right up next the sentinel node - their feeling is that having two clear nodes provides a better assurance that the nodes are clear than just having one clear node. 

Second, it depends on whether a sentinel node biopsy was even possible or advisable. Sometimes the dye/isotopes don't move to the nodes at all, and in those cases, an SNB isn't possible and an axillary dissection (or a modified version of an axillary dissection) must be done instead.  Sometimes the dye/isotopes move to too many nodes; in that case as well an SNB can't be done and more nodes must be removed.  Then there are cases where someone presents with a large aggressive tumor and swollen nodes; in this type of situation, a surgeon might choose to not do a sentinel node biopsy and instead move straight to an axillary node dissection, removing many more nodes.  This is less likely to happen these days, with the new research that's come out about the benefits (or lack of same) of axillary dissection, but it used to happen a lot. But this is the sort of situation where someone might have 20 nodes removed, and all are found to be positive.

Third, if an SNB is done and 1 to 3 nodes are removed (that's the usual number) and if nodes turn out to be positive, then often this will lead to an axillary dissection, with more nodes removed. Here again this practice is becoming somewhat less common thanks to the new research but I'd guess that this is still the general practice, since the research is so new and hasn't been incorporated yet into treatment standards (and perhaps won't be until it is verified by more research studies).  

Emaline

Okay, follow up question, and I appreciate the patience   Is the number of nodes that light up purely a random thing?  Or is this related to the cancer in same way?  And lastly (if you believe this, I have much land to sell you) what is the difference between this type and the axillary? 

My surgeon said if he gets clear positive in my nodes, he will take them all in that area. I'm assuming that is the axillary?  With surgery looming on Friday, I'm still back and forth on if I agree with this practice or not. I talked with our physical therapist director at where I work, and she said she doesn't agree with this practice anymore and that it does more harm then good. I am not disparaging her in any way and know she has helped many with lymphedema, but she is not a breast surgeon or oncologist.

julianna51

Is this always done in all MX?  I have not heard anything from my BS about this but I am meeting with him on Friday.   I am just feeling scared that there is so much more to this than I am expecting.

Beesie

Emaline, the number of nodes that light up is purely a random thing.  There's no connection to the cancer.  And to your question, a sentinel node biopsy (an SNB) is a method used to test the lymph nodes by removing only a few nodes rather than the whole first and second level of nodes. The reason that more and more SNBs are being done is because the fewer nodes that are removed, the lower the risk of lymphedema. Here are explanations from this website (I hope the links work) of the different processes:

What Can You Tell Me About Sentinel Node Biopsy? 

Sentinel Lymph Node Dissection 

Axillary Dissection 

julianna, as a general rule, lymph nodes are always checked whenever someone has invasive breast cancer.  For those who have DCIS, it is not necessary to check the nodes. DCIS cancer cells are confined to the milk ducts and by definition cannot travel to the nodes.  However, where there is DCIS, there is always a possibility that some invasive cancer might be found - approx. 20% of women who are diagnosed with DCIS through a needle biopsy are ultimately found to have some invasive cancer (usually just a tiny microinvasion) once all the surgery is done and all the affected breast tissue has been analysed.  This risk is greatest if the DCIS is high grade and/or large in area.  Therefore, for women who have high grade aggressive DCIS or large areas of DCIS, sometimes a sentinel node biopsy is recommended just in case some invasive cancer is found in the removed breast tissue after the surgery.  This saves the patient from having to undergo an SNB later. An SNB is most likely to be recommended for those who have high grade and/or a large area of DCIS who are undergoing a mastectomy, because the process to do an SNB is more difficult after a mastectomy.  An SNB is done by injecting dye and/or isotopes in the breast, either in the area of the tumor or around the nipple. The injected fluid travels through the breast to the lymph nodes; the nodes that "light up" are the ones that are removed during SNB surgery. Obviously, if the breast has been removed, it's more difficult to do an SNB.  So those who have DCIS who are having a lumpectomy can opt to pass on having an SNB; if some invasive cancer is found, they can always have the SNB later.  For those having a mastectomy, usually the SNB will be done at the time of the mastectomy.

Hope that all makes sense.  

duckyb1

Beesie............I was told by a Board Certified LE specialist, that I may have beginning states of LE... Let me tell you what she said after she measured my arm, and she did it with my putting dots all up and down both arms, and them doing a comparison by measuring.

I said to her the I was annoyed , but I did realize that my BS had to removed the nodes (8), because he could not detect the SN since something didn't work with the dye...I said to her "had he not taken out any nodes I would not be having this LE problem right now, and damn it, they were all negative anyway, which defeated the purpose in taking them.

She said "no he had to do exactly what he did, otherwise he would have no way of knowing it they were malignant or not.

Then she said "node removal can cause LE.........but.......everyone who had nodes removed does  not get LE....only 20-30% of people get it.

Then told me that she was a BC survivor who had 25 nodes removed, and many were positive, and she never got LE. and then said she has treated women who had as little as 2 nodes removed (less then me) and they got LE too...........She said it all depends on how the lymph fluid flows through the arm.....if it doesn't flow the way it should, it will accumulate, and you will get LE...............She is Board Certified, and has been doing it for 25 years.

It explained it all to me, and when she was done, I said "of course, I would be one of the 20-30%. So she is the person I am trying to go to.........out of network.........since she only takes medicare.......she did my original evaluation "gratis", and this woman knows her shit, so I am fighting like hell to get her........there are no other Board Cert. in our area.  Hope I win this on. and honestly today this arm is sore, like an aching throb....really annoying.  hugs.