How Is it Decided How many Lymph Nodes to Remove and Test?

kec1972

I see while on here that some have had 4 nodes taken out, some 3, some 2, and some only one(I am in the last category). I was wondering if anyone knows how the surgeon determines how many nodes to test? I got injected with a tracer before my lumpectomy, but that's all I know. The one node he took was clear of cancer, but now I wish he took one more just to be sure....ugh, I hate driving myself crazy..

Samnjb

hi

When they did my sentinel node dye test I had 3 light up so they took 3. I think they told me that everyone is different in how many light up during that test.

ComeOn2019

As stated above, it depends first on how many “light up” after the injection. But it’s also not a 100% exact science. My surgeon said he got my SN and two teeny tiny others came out with it, so while he was shooting for one I had three removed.

edwards750

I had a micromet in my SN. That was the only one they removed. My MO said there was no need to remove anymore.

Diane

letsgogolf

I wondered this as well because I thought they were going to take only 1 node and they took 8. I had micromets in my first none only. The others were clear. Maybe somebody will come along and explain this better than I but my understanding is that they use a gamma detector (sort of like a geiger counter) after the nuclear injection. They remove tissue within a certain range on the counter. They don't actually know how many they are removing until they are looked at in the lab because they remove a pad of tissue and the nodes are imbedded inside. The nodes are various sizes and everybody has a different number. I was told that some are as small as the head of a pin and others the size of a lima bean. If the first blue node is negative I don't think then even check the others.

DATNY

I asked my surgeon this question before surgery. He said that in my case he will remove certain area, known to contain lymph nodes, called level 1. But there is no way to tell how many will be there. For instance, it could be four or twenty. That can only be found after the tissue is removed and analysed.

SummerAngel

DATNY is correct. The removal is targeted by the injected dye, but there may be quite a few nodes in the tissue removed. Everyone has a different total number of nodes as well. It makes me wonder if that's why some are more prone to lymphedema even if they have few risk factors. If you only start out with a small number and some are taken there may not be enough left to do the job.

santabarbarian

My surgeon told me there was a protocol, and that taking several (4) nodes gave more reliable results than one. BUT-- in my case, we knew there was cancer in at least one node when I was diagnosed, and a few others were enlarged at that time too. After chemo my MRI, mammo and US all showed zero cancer remaining, though the formerly-cancerous node was still enlarged.

The current surgical protocol for people who have 4 nodes upon presentation is taking all level one and two nodes. But I pushed back a bit, because of the post chemo imaging being so good. (I did not want lymphedema!) I asked, how come # of nodes at presentation is the trigger of this surgery? Am I really in worse shape now than someone who only had two or three nodes upon presentation, but no pCR from chemo?

She agreed with my thinking, and mentioned that all the protocols have gradually been changing in a less and less invasive direction... Our compromise was her taking the known bad node + 4 more likely nodes identified by the radioactive (sentinel) injection, and if there was any live cancer in any of it, I'd let her go back in and take them all. I agreed to that and got lucky with a pCR. I was SO HAPPY I had pushed back and had the less invasive surgery.

And as it turned out, she only took 3 sentinel nodes as there was not a "likely" 4th and she did not want to dig around when she could see that everything looked consistent w pCR. The big node was dead, and upon path report it turned out I had dead cancer in just one of the 3 she took.