What happens if they can't find sentinel node?

rk85

I'm scheduled for a BMX with SNB later this month, and have read that sometimes they can't locate the sentinel node.  Especially if you've had a large biopsy previously, this may disrupt the flow in the breast.  What does sometime with high grade, large area (4cm) of DCIS removed on excisional biopsy do at this point?  Tell the surgeon to not remove any nodes, take a guess and pull the one he thinks is sentinel or take them all out?  I want to say don't take any and lets wait to see what the path on the removed breast says, but I have read that they only look at a representative sampling of removed breast tissue and that the SNB is a more sensitive and accurate test to detect occult invasions.

RetiredLibby

I had a bmx on August 23 for recurrent DCIS.  Since I had had radiation on that side, including the axilla, four years ago after my first go-round with DCIS, the surgeon was unable to find the sentinal node at my BMX.  Neither the radioactive tracer nor the blue dye revealed it to her. 

She didn't want to do a full node dissection because it is DCIS.  Typically, she wouldn't even do a SNB for DCIS ... she was only doing it out of an abundance of caution since I had a reocurrence and it was Grade 3 with comedo necrosis. 

Both my areas of DCIS were small-ish ... the initial one was less than 1 cm.  The recurrent DCIS was 1.5 cm.  The pathologist did look at the inframammary nodes and they were clear.  He also looked carefully at the entire DCIS lesion and there was no evidence of microinvasion.

You might want to ask your breast surgeon what happens in that case in your hospital.

 Good luck!

L

Mantra

They had a very difficult time finding mine. I remember lying there for a very long time with my arm above my head. She kept checking and nothing was happening. I was getting nervous and she some people take much longer than others for the dye to go through. In the end, it turned out I had two sentinel nodes plus they removed one more.

My doctor said normally her patients go in the night before to allow much more time for the dye to travel through.  My surgery was on a Monday so I had to have it done in the morning.

Is yours being done the night before.

rk85

They are doing my SNB at 1pm and the BMX is scheduled for 4:30 pm at South Miami hosp.  Sounds like they are expecting it to work fast, but what if it doesn't!  I feel like I have defied the odds to get BC at 43, negative BRCA and a healthy lifestyle, I no longer feel comforted by odds like "only a 10% risk of this or 5% risk of that".  If it is more than 1%, I want to be prepared for it.

Happylibby, so did they take out your inframammary nodes at BMX?  I don't think the pathologist could examine them while they are still in right? (wouldn't that be nice!)  Also are inframammary nodes your level 1 nodes? 

RetiredLibby

Rk85, the intramammary (sorry, I spelled it wrong ... My iPad is hard to type on!) nodes are the ones inside the breast. They came out when the breast comes off. The pathologist at the hospital located some in my removed breasts and examined them for cancer and they were clear. Level 1 nodes are axillary (armpit) nodes. I didn't have any of those removed.



I just saw my oncologist for a post-surgical visit and she does not expect to see me again since I had a BMX. Tamoxifen failed me, so I won't be taking it anymore. She said my risk of recurrence is very low, if any (yeah, heard that the last time!). None of the AIs are indicated for DCIS, so I won't be taking them, either (and besides, I am STILL pre-meno!). So apart from healing from the surgery, my followup will be once a year with the breast surgeon.



L