Lymph node results: initial diagnosis vs. found at surgery?

IDCSister

Hi,

My sister is in her 2nd round of chemo and doing poorly - it's so hard to watch. I had a question... I know most people get their diagnosis including the # of lymph nodes affected via scans. But then, come surgery time, that is when the true number of lymph nodes is actually confirmed.

I'm wondering what everyone's experience was with this... was your initial diagnosis of affected lymph nodes the same as what was found at surgery? Or different, and if so, what was the difference? (For instance I know of someone who had 0 lymph nodes seen on scans, but then at surgery they discovered 2).

Thanks, just curious.

LM070917

I had an ultrasound when being diagnosed and the radiologist thought 5 of my lymph nodes were cancerous.

My GS decided to do axillary lymph noderemoval and removed 14, only 2 ended up being cancerous though, not 5, which was a bit more of a relief.

ChiSandy

I didn't get my lymph nodes scanned at diagnostic ultrasound, just had a sentinel node biopsy. Interestingly, my friend who was recently diagnosed with DCIS did have her nodes scanned via ultrasound, and tentatively they're clear. She won't get SNB unless she either elects a mastectomy or the lumpectomy reveals invasive cancer as well as DCIS--a possibility since her DCIS is Grade 3 with both cribiform and comedo necrosis--which indicates a tumor that is faster-dividing and more likely to mutate to acquire the ability to become invasive

JenPam

Scans and exams indicated I had healthy nodes, but during my BMX, my surgeon ended up removing what turned out to be 22 cancerous nodes out of 25

chef127

My LN's seemed to be clear before surgery but the surgeon did a Bx and the node was found to be cancerous, a clip was placed, on to surgery, 8 nodes removed all clean one with micro mets so I held on to that result regardless of that effected node??????? I was a bit haunted by the positive node that was clipped so I went back and asked for an us to find that node and clip and there it was.

So it sat there for 6 months, brewing and getting more advanced. Apparently the blue dye can bypass a node full of ca with a clip so I had the surgery to remove it plus 1 more and the the rest seemed clean at observation?? When I had rads I assumed the nodes were clear so I refused rads to the underarm.

Maureen

ThinkingPositive

mammogram and ultrasound found DCIS but then the MRI found additional lesions but never found anything in the notes it wasn't until I had my Mesec to me that they found one node out of 17 that had cancer and it was 8 mm and it had extra capsulated extension 27th feel like 10 to 20. So you never know now I worry all the time

muska

Scans before surgery including MRI did not show anything suspicious in lymph nodes. During surgery several macro metastasis were found in lymph nodes. Staging went up from 1 pre-surgery to 3 post-surgery.

readytorock

I showed no sign of cancer in lymph nodes - even after surgery, the surgeon said they looked healthy. Results came back 1 out of 6 was positive though.

tangandchris

2 was the initial finding with scans...after surgery I had 25 removed and 6 were positive...some had extranodal extension...I think I'm spelling that correctly. It is fairly common for this to happen, the scans can only tell so much. I'm sorry for your sister ((hugs))

snorkeler

Before surgery, ultrasound and MRI scans showed clean nodes, but I ended up having a mircomet in one out of three sentinel nodes.

NatsFan

I had a palpable lymph node which was biopsied prior to surgery and found to be positive. At surgery 15 nodes were removed, but only that one was positive.

ksusan

MRI showed two suspicious nodes--one in the breast, one sentinel. They were both confirmed to be positive after surgery.

I'm sorry your sister is having a hard time with chemo.

BarredOwl

Hi IDCSister:

In another thread you noted your sister was diagnosed with a "Grade III 2.9cm tumor. Triple positive (HER2+, ER+, PR+)" and is receiving neoadjuvant chemotherapy prior to surgery: "She had her first chemo yesterday (TCHP) which will then be followed by a double mastectomy and possible radiation."

Those above seem mostly to have had surgery first. You may receive more information from those with similar treatment plans by posting your questions in the HER2-positive Forum, and more specifically, the triple-positive thread, where many women are or have received neoadjuvant chemotherapy for triple positive IDC:

Triple-positive group:

https://community.breastcancer.org/forum/80/topics...

BarredOwl

IDCSister

Thanks all for your responses. and Barred Owl, I will do that, good point! Thank you.

daisylover

Pre-surgery I was told stage 1, no nodes involved -- no cancer felt in nodes on Palpation, none shown on MRI. BS told me nodes were clear after surgery before pathology report...

I did have 2 nodes with cancer at SNB (at time of lumpectomy) on pathology report, but ALND (at time of BMX) found no more cancerous nodes.

With ILC, could be difficult to feel and see?

Creativevintage

I had one node that was positive by FNA when they biopsied the breast mass. I had neoadjuvant TCHP and when they did SNB the node was negative. I had four nodes removed, all were cancer free. YAY TCHP! I still had residual IDC and DCIS in the breast tumor, grade 2, but staging was not stage 1 and I had clear margins.

Anonymous

My scans and imaging didn't show anything in the lymph nodes, but one was found positive during surgery by frozen section. So the surgeon went ahead and removed 22, but only that one had 4mm of cancer in it. I was stage IIa but I was restaged to IIb.

ThinkingPositive

Did any of you get the oncotype test? My MO said mine would probably come back high so no reason to do it. I wish now I had done it. Always wondering what my score would have been with a positive node.

Anonymous

ThinkingPositive, I had the oncotype test done. My insurance covered it too! My recurrence score was 15, low risk. So I'm very happy that I had it done. There is a study going on right now (RxPonder) that's looking at women with recurrence scores of 25 or less with 1-3 lymph nodes positive and if Oncotype can apply to them. Half of them did chemo+hormonal therapy and half did only hormonal therapy. We won't know for a few years but an oncologist I saw reassured me by telling me that all the studies so far have verified the oncotype test.

snorkeler

I think that one node's micromet surprised everybody, so my MO ordered the oncotype test. Results came back low (barely) at 17, so even though some cells from a small tumor made it to a lymph mode, it's still considered low risk.

ThinkingPositive

I guess since I was a grade 3 with some Lvi and extracapsulated ext in the one node that's what made him say it would be high. Wondering if there could have been a chance that it may have come back not so high.

Anonymous

ThinkingPositive, with grade 3 and LVI and the extracapsulated extension, I would have also done chemo. I didn't have either of those, and my tumor cells were dividing slowly, so all of that with the oncotype made me say no to chemo. Each situation is different and no one really knows what's best except for you. I think you made the right decision. How are you doing with chemo? Are you almost done?

ThinkingPositive

lovingisliving...I finished chemo one year ago. I am now on letrazole (Fermara) for 10 years. I finished reconstruction and had both ovaries removed. I Sti worry all the time. I was given the choice of two chemo regimes oncologist would not tell me which one to chose it had to be my decision. I went with the tc rather than act due to the problems act may cause to your heart. I have high blood pressure so I didn't want anything to worry about . Hope I made the right choice. I often wondered how high did he really think the oncotype would be. I would have done chemo no matter what with a positive node but I wondered whether he didn't want me to know what the score was in case it was super high. But something like that may have just pushed me to act. It done and the only thing I can do is move forward and try not to worry?? How are you dealing everyday

Anonymous

Oops I misread the dates on your signature. Do you know how much cancer was found in the lymph node? Mine had 4mm but the pathology classified it as 'micrometastasis'. I thought anything more than 2mm was macro. I read through my pathology again and I saw for the first time that my tumor was 30% dcis and 70% invasive. Funny what you can find reading through it after a few months.

Both oncologists I saw quoted me a 5% benefit from chemo over 10 years. According to oncotype I would actually lose 1% by doing chemo. It was a tough decision, especially since my brother has stage IV breast cancer. He has been in treatment for the past year. It has been hard on him and us too. Genetic tests came up with only one variance of unknown significance that is likely to be benign.

Believe it or not, there are times where I don't even realize that I actually went through surgery. It hits me when I have to take the tamoxifen though, usually in the form of a hot flash. I try not to dwell on it and I feel like so much of the outcome is due to chance. I've seen women here who do everything and still progress, and women who do hardly anything and go on for the rest of their lives cancer free. All we can do is keep our faith and always think positive, like your screen name. Laughter and prayer are my best medicines. I have low points but I don't let it linger. I hope you can find something happy to get your mind away from stress and worry.

Best wishes to you. Have a great night.

ThinkingPositive

I had 8 mm in the node. The idc lesion in my breast was 11 mm. My MO was

ThinkingPositive

The cancer in the note was 8 mm so they say. My IDC lesion in the breast was 11 mm. I also had DCIS as well. I didn't feel I had enough time to go get a second opinion I was very frantic and I wanted to get things moving as quickly as possible. My MO kept telling me don't focus on that focus on that whenever I would ask questions like but there was LVi there was a ECN he would say don't focus on that.

etnasgrl

My ultrasound and MRI showed no lymph node involvement. The surgery proved that to be true.

Logang

I had one lymph node that looked abnormal on ultrasound and many that looked abnormal vs. the unaffected side on MRI. I had the one biopsied that the ultrasound showed and it was clear. When I had my right mastectomy, my surgeon ended up taking 31 nodes because they didn't look right and he wasn't comfortable leaving g them. They were all clear!