Inner lower quadrant location & mammory node

HeatherT75

I am new to this group and am very happy to have found it. I was diagnosed with ILC 9/27 and had a double masectomy on 10/25. The surgeon did sentinal node mapping and an axillary node was biopsied and was clear. My tumor was located in the lower quadrant (3 o clock) and I am concerned with mammory lymph node involvement as the tumor was much closer to those nodes than the axillary. I was told they do not usually biopsy when I talked with the radiologist. When I talked to the surgeon she didnt really answer my question where it made sense I guess. My question for everyone is if anyone has had experience with a tumor in the inner quadrants and either positive or negative mammory node involvement. Also would the sentinal node mapping pick up on a mammory node if it was the one most likely to be affected? Thank you all.

Betrayal

HeatherT75: I would be interested in the responses you get because I was left, lower, inner quadrant at 6:30 and asked the same questions. It seems the only nodes they checked were axillary and only located one which was negative. I was concerned since I had a mixed tumor and the intramammary nodes were closer than the axillary ones. I was told they do not routinely check them because they would be "too hard to remove" if positive and "that is not the way the lymph nodes drain. I found this disconcerting but whenever I tried to explore it, I was shutdown and redirected by the BS or RO. I would ask lots of questions and see what responses you get since it is your body and life. Good luck.

Mavericksmom

I too would be interested in an answer. I had the entire first tier of lymph nodes removed when I had IDC in 2003, all negative. Last Dec I was diagnosed with ILC and no lymph nodes were removed because they were removed in 2003. I still wonder if it went to other nodes.

I assume if it did, I will feel a hardening or lump under my reconstructed breast. I am not sure if this is a correct assumption.

downdog

The IM or parasternal nodes can be imaged via US or CT scan. This lymphatic pathway does drain ~25% of the breast. Whether for accurate staging or continued surveillance, you may wish to advocate for additional imaging. If your doctors were evasive or dismissive, you could consider a second opinion. If you have a very small, grade 1, hormone postive, HER2- tumour, the medical consensus might possibly be that the additional testing is not warranted, but do what you need to for peace of mind. 

Here's some info I found with some quick googling:

https://www.dartmouth.edu/~humananatomy/part_2/chapter_7.html  

https://posterng.netkey.at/esr/viewing/index.php?module=viewing_poster&task=&pi=143512

https://www.ajronline.org/doi/10.2214/AJR.13.11148

There are various techniques that are administered in different treatment centers with respect to the injection of the radio-tracer in a SNB. Some inject it in the quadrant of the breast in which the tumour is located. My facility injected it in four locations around the areola: 12,3,6 and 9 o'clock. I have no medical training, but in my opinion, a more equally distributed injection of the radioactive tracer would facilitate uptake in the actual lymphatic drainage pathways of the breast, and if someone had IM nodal involvement, node(s) in this lymphatic chain would light up. They are located under the sternum between the intercostal spaces and very difficult to remove surgically. Evidence via imaging or even radio-tracer uptake would be considered in the treatment protocol recommendation, e.g. chemo  

Good luck to all