Sentinel Node Biopsy: Standards of care?

msShelly

Hello,

I recently had a Sentinel Node Biopsy done in which 0/3 sentinel nodes were said to be positive for cancer. I have a 1.1 cm tumor. 

I have been doing some reading and recently found out that there are different methods for detecting Sentinel Nodes- 1. Blue Dye, 2. Radioactive Tracer, 3. Blue Dye + Radioactive Tracer.

I know at hopkins they do #3. Blue Dye + Radioactive Tracer and that some studies show this is the most accurate.

Well I was treated by a chief at one of the top 4 hospitals- don't want to say the name, but i thought that the chief would do what is considered the best standard of care, especially given the prestige of the hospital, but apparently the chief only does Lymphazurin Blue Dye techniqe intraoperatively. The chief is also ranked as a top us doctor, top 1% of the field by us news & world.

Hearing that other women might have been treated differently has me somewhat worried. Does anyone know more about the different techniques and studies proving their accuracy? Can I believe that the SLNB was accurate?

My tumor was fairly small and my oncotype was low, so the chances that my sentinel node was positive are low according to the nomogram, but now I worry because I don't understand why a chief at the top hospital is using an outdated technique?

Furthermore, none of this was explained prior to the surgery and I have just learned about the differences in techniques. 

Thanks!

Beesie

Shelly, most of the more recent studies I've seen indicate that blue dye alone is just fine.  It is the experience of the surgeon that is most important with an SNB, not whether it's blue dye or the radioactive tracer or the combination of both. The other factor that improves accuracy is the number of nodes removed. 

If you'd had only one node removed, then I could appreciate that you might have a very small amount of concern about the fact that only the blue dye was used. But having had 3 nodes removed and all found to be clear, I don't think you have any reason at all to worry.  

Don't over-think or over-analyse things.  It will only drive you nuts!   You had a small, early stage breast cancer; after surgery and treatment, you have an excellent prognosis.  Go with that. 

msShelly

Thank you beesie! I do think I am over thinking things  A LOT! It is always surprising to find things out after surgery, but the surgeon is said to be very experienced, with over 20 years of surgery. I read somewhere that the average lymph nodes taking during SLNB is 2, so I am glad at least I have the 3 telling me they are negative.  It is also good to hear that the newer studies indicate that blue dye alone is good. Is there a good database to find updated studies?

ICanDoThis

I had intraoperative blue dye alone, also. My surgeon was very experienced - was part of the Clinical trials for Sentinel nodes. He said that he was totally comfortable with this technique, it was newer, less experienced surgeons who were likely to not find any problems, but that the standard was tracer.

We did this because I have a disabled child, and trying to arrange for the extra time to get in for the test simply didn't work.
I'm over 5 years out, so it looks like he was right