Can it skip the sentinel node?

WC3

I wasn't really sure where to post this, but did anyone have a clear sentinel node biopsy but cancer in axillary nodes?

SpecialK

Mine didn't skip exactly, but the answer is yes it can. I had 20 isolated tumor cells (ITC) in the sentinel - could be considered clinically node negative or biopsy artifact, but had a much larger positive node further up which was not detected by palpation or by MRI. The much larger cancer in the axilla was further up and found five weeks after BMX in a level 1 & 2 completeaxillary dissection (ALND) done at the insistence of both my BS and MO. There are several others here on BCO with the same. Here is an interesting article that discusses the false negative rate of SNB, but the consensus also seems to be that adjuvant systemic treatment (chemo, anti-hormonal), and local treatment(rads) does a good job of minimizing locoregional recurrence in cases of false neg SNB.

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5127992/

WC3

SpecialK:

Thanks for the reply and link!

LeesaD

I had two of four sentinel nodes with just micromestasis which is less than 2 mm’s of cancer. My MO and BS said odds were slim to none other nodes would be involved. I pushed to have ALND and surgeon took out fourteen more nodes and two of the fourteen were fully positive with 4 mm’s. My oncologist and surgeon called me within minutes of each other when those results came in. My MO was basically in a panic and my surgeon said good thing we went back in. Umm yes it was but if I left it up to them they wouldn’t have. It changed my whole course of treatment.

Nas

My pathology report only says 8 nodes tested and one was positive , I really havo no idea if that node is sentinel or auxiliary node, it even doesn't say how much cancer was found in my positive node neither if there wasextra capsular, My MO said you are between stage IB and IIA🧐

Salamandra

Hi Leesa,

It's so good that you advocated for yourself, and scary that such an easy thing to miss can make such a big difference for treatment. Do you remember what made you feel so confident to push for the ALND?

I know ALND has its own risks, but it is still unsettling to think how many of us must be walking around thinking we're 0/X for nodes, but it's not true.

I'm also wondering if you had the Oncotype test done, and what was it? Like, was it high enough to be a clue that there was more than meets the eye, or was it playing along with pretending everything is fine?

LeesaD

Salamandra, I pushed for the ALND as I know myself and knew I just could not live with the unknown. My MO at our first meeting said you don't need it and there's the lymphedema risk and it's not standard for micromets... I said how do you know cancer has not spread further and he said I don't. He ordered the Oncotype score at that first meeting and I went home from my appointment. My breast surgeon called me day after on a Saturday and said oncologist called him and he said to me so I hear you want to go back in? I said yes so I'll have peace of mind and know for sure. It's not that I thought I knew further nodes were positive, I just knew had to know definitively either way. Saying 'we don't know' was not good enough information for me. I knew I was better suited to deal with lymphadeema risk than livingrest of my life not knowing. He said ok we'll go back in and scheduled me for the following week. So two days after ALND they called with the 2 of 14 'full of cancer' as my MO put it. He said chemo now is automatic regardless of what Oncotype score comes back as I now had four 'involved' nodes. He set me up for port placement and to begin AC+T chemo. So a couple of days after port placement I get my Oncotype results. MO calls me and says result is a 3. Lowest he's ever had in a patient. So he's encouraged now by the low score and instead of AC+T he says I'm not going to give you Adriamyacin as heart risk from this drug far outweighs any benefit with such a low Oncotype score. He then set me up for TC four rounds. Oncotype is really only relevant for 1-3 nodes involved so he said he still had to give me chemo. I was ok with it. I did the chemo and also 25 rounds of radiation which is also standard for 4 involved nodes. It's been almost two years since surgeries and no lymphedema yet with 18 nodes removed.

if I didn't push and have the ALND, the only info I would've had to determine treatment would have been 2/4 sentinal nodes with just micromets and an Oncotype of 3. No doctor would've recommended chemo with such a low score, radiation would not have been recommended due to the BMX and I would've been sent on my way with just anti hormonals and two fully positive nodes still there. I would've had no clue. That thought makes me ill to this day. I had one shot to get it right and I have no regrets.

WC3

LeesaD:

I'm glad you pushed for the ALND!

Adelozier

I was nice neg and 15 months later a node was found..

right beside the snb that was positive ... if I hadnt pushed so hard I'd be dead ...