Lymph node biopsy after mastectomy?

akmom

Does anyone have experience with lymph node biopsy AFTER mastectomy?

My stereotactic core biopsy identified DCIS in both breasts. Due to previous radiation of the right breast (6 years ago) mastectomy was indicated and I opted for BMX. Path report came back showing a tiny (3 mm) invasive cancer in the right breast, along with “extensive" intermediate to high grade DCIS. Left breast was intermediate grade DCIS only. Four small intramammary lymph nodes (right breast) were negative for metastasis.

My surgeon (general, not a breast surgeon) did not perform a sentinel node biopsy, I guess assuming that there was only DCIS present.

I have been referred to the Cancer Agency for follow up, which will likely be treatment with Tamoxifen, according to the surgeon. He said that doing an axillary node biopsy after the fact is possible but in his opinion would be “overkill".

Really wishing my surgeon had done the SNB in the first place (but I didn't press him on it as I was worried about the risk of lymphedema).

What are the chances that tiny bit of IDC managed to send out feelers before the MX, I wonder? Has anyone else had a lymph node biopsy post MX

downdog

The mastectomy removed the lymphatic vessels that the tumour area would have used to drain. No matter how skilled the BS, it is not possible to have a high degree of confidence that any nodes that would be mapped and identified post-MX would be the same ones had it been done prior to the MX. Given that it was 3mm, HER2- and not grade 3, and you don’t mention LVI, which is low probability with your diagnosis, it is very low risk that it had spread to nodes. So, more surgery to remove 1-4 nodes that no one can say with confidence are the same ones the rumour would have drained to, and with your situation, a BS is more likely going to want to remove 3-4. Like all treatment decisions, it is a personal decision based on your comfort level with risk. Some women throw the kitchen sink at their treatments. If I were in your shoes, I wouldn’t risk lymphedema and possible recovery complications for questionable information. Best wishes in determining the right decision for yourself.

akmom

Thank you downdog, that information helps me feel more comfortable with this situation. I am happy to just go with whatever hormonal treatment the oncologist recommends and won't worry about the unlikeliest scenario

Legomaster225

I have a similar situation. I had a BMX and the left was supposed to be prophylactic Upon removal they found 9mm IDC in my left breast which was previously “clean” based on two MRI’s. No node testing was done on that side since there was no indication if disease. My BS said that if I wanted we could do a full node dissection on that side if I really wanted it for peace of mind but he did not recommend it and similar to you thought it was overkill as the breast was removed. So I am just taking tamoxifen (switching to AI next year). He did say we could do axillary ultrasounds annually to monitor the lymph nodes on that side to give me peace of mind. We just did that about 10 months after BMX and everything looks ok. Hindsite is everything huh?

akmom

Yes, hindsight is 20/20. Glad there is a way to monitor the lymph nodesat least. Hope all continues to look okay on the “surprise” side.

akmom

Saw MO yesterday and will be starting Letrozole (Femara) next week. She said it should reduce my 10 - 15% risk of recurrence by half. (Hoping for minimal side effects... fingers crossed.)

She didn't recommend lymph node removal; guess that ship has sailed