Micro metastasis Sentinel node after NeoAdjuvant chemo

Docy

I had lumpectomy and 5 Sentinel nodes removed on 5/13/21.

Finished Chemo for HER 2 positive invasive BC on April 12 th.

Now after surgery found out that I have one lymph node with micro metastasiis and another has treatment effect.

I had positive lymph node on Scans prior to chemo, unfortunately, the lymph node was not biopsied and tagged.

So now BS does not know regarding furthertreatment. She thinks probably Radiation therapy would be OK, but not sure if I need Axillary lymph node disection.

Waiting for Tumor board review for their recommendation.

Any one had similar results and if so can you share what treatment was given.

I'm puzzled and worried and not happy with my first BS, that did not biopsy and tag the positive lymph node seen on the PET and MRI scan. So it is not known if the positive node after surgery is same or not.

The concern now is do I have more positive lymph nodes

.Thanks in advance!

LeesaD

Not exactly same as I have different hormone receptors than you as I'm ER/PR + and Her2 - and I had chemo after surgery not before. I had two of four sentinel nodes show just micromets. My doctors did not recommend ALND as they said with just micromets odds slim to none they'd find further during ALND. I pushed for ALND and sure enough I was an exception and found 2 of 14 axillary nodes taken were fully positive with more cancer than what was in sentinel nodes. Changed my ENTIRE treatment plan finding those axillary nodes as my Oncotype was a 3 so would've skipped chemo. I had radiation as well. Again not same situation as you exactly but sometimes those cells get past the sentinel. Hope others chime in who are more knowledgeable than me. You already had chemo so I think it's just whether you're comfortable with radiation taking care of anything that could be there still or if you want to check. I think there are studies that show radiation just as good as ALND without the lymphadema risk. Personally I wanted to know definitely but that’sbecause I knew I couldn't live with not knowing and am willing to deal with lymphadema issues if they arise. Best of Luck to you!

Docy

Thank you LeesaD for your reply.

I went to a big university center and put all my trust in BS and her judgement.

I will have to continue Herceptin for a year and was told I need Radiation any way because of size of my tumor. There was completes regression of breast tumor with chemo.

Now I will have to figure it out what I need to do. Unfortunately, micrometastasis after NeoAdjuvant chemo does not have any studies and concrete data yet. Most of the studies were on surgery before chemo.And most did not push for ALND.

Glad you pushed for it and very happy for you.

Melbo

I had PCR to my TCHP chemo, but my oncologist told me that if I didn’t get a PCR he would most likely start me onKadclya, which seems to be a common next treatment for ER/PR neg, HER2 pos. One of the women in my chemo group (from last May) went on Kadclya because she didn’t get a PCR.

Docy

Thank you Melbo for the information

Will ask my MO about Kadclya, and like to know how well it is tolerated and side effects from any one taking this drug.

O2s

curious to know what tumor board decided?

Docy

Tumor board recommended ALND because my ordinal scan positive lymph node was not biopsied and tagged.

So I got second opinionfrom MO and she agrees with my MO to go head treat with Radiation to breast and Axillary and Kadcyla. So decided to take the small risk and not have ALND