negative nodes ending up with Mets - numbers?

barbe, KerryMac has already started through Access Zometa. She's the one who told me about it. I'll let you know what happens. While it doesn't hurt to get another opinion at PMH, I'm sure you don't have to worry. .....easier said than done I know.

: Ann Surg Oncol. 2009 Sep 24. [Epub ahead of print] Related Articles
Axillary Recurrence Rate Following Negative Sentinel Node Biopsy for Invasive Breast Cancer: Long-Term Follow-Up.

Kiluk JV, Ly QP, Meade T, Ramos D, Reintgen DS, Dessureault S, Davis M, Shamehdi C, Cox CE.

H. Lee Moffitt Cancer Center and Research Institute (MCC), Tampa, FL, USA.

OBJECTIVE: Sentinel lymph node (SLN) biopsy has replaced axillary lymph node dissection (ALND) as the definitive nodal staging procedure for breast cancer. SLN biopsy has been proven to cause less morbidity and be more cost effective than complete ALND. Short-term follow-up has shown that lymphatic mapping and SLN have a low false-negative rate, but there is limited data demonstrating long-term outcomes within a large consecutive series of patients. METHODS: Retrospective review of a prospective database of breast cancer patients at our institution was performed. The initial mapping of 1,530 patients with invasive breast cancer who demonstrated a negative sentinel node biopsy and no axillary dissection between January 1995 and June 2003 were collated and reviewed to achieve a long-term follow-up. These 1,530 patients were reviewed for follow-up time, local recurrences, distant metastases, and survival. RESULTS: 1,530 consecutively mapped invasive breast cancer patients had a negative SLN biopsy and no ALND. The mean invasive tumor size was 1.40 cm. Of 1,530 patients, 73% (1,121) underwent lumpectomy and 27% (409) underwent mastectomy. Mean follow-up was 4.92 years (range 0-12.0 years). There have been 4 (0.26%) patients presenting with local axillary recurrences, 54 (3.53%) patients presenting with local recurrences in the ipsilateral breast/chest wall, and 24 (1.57%) presenting with distant metastases. CONCLUSION: These data confirm that SLN biopsy is an effective and safe alternative to ALND for detection of nodal metastases in patients with invasive breast cancer and should be used as the standard tool for nodal staging.

PMID: 19777181 [PubMed - as supplied by publisher]

After my cancer I went back to school for Reg Nurse.  I took care of a woman who had mets with no lymph node involvement, I was shocked, I had no idea this happened.  It is a small number but it happens.  I was shocked because before that I really believed that no lymph nodes meant you were safe.  After seeing that situation,I learned that we all must be aware of any changes, regardless of stage or nodes. If they offer treatment, take it if you are healthy enough to get through it. The Dr's know best, bring your questions to them. 

Cancer can be very sneaky, do not take any chances.........fight your battle upfront

THat's what I worry about!   My tumor was inner breast right at cleavage area.  Sentinal lymph node (axillary) was negative, but what about the intramammary ones!!!!???  My oncologist said that a CT scan would show if there was any involved cancer in them, but then rushed me into chemo saying that it was better with an aggressive cancer to just treat it as soon as possible after surgery rather than waiting and trying to get more info about it.  She said with an aggressive cancer, staging and other things they use to help determine treatment, is really irrelevant.  Regardless, the treatment would be the same--you have to treat it as if "the horse has already been out of the barn" even if there is no evidence on paper.  Thrilling for me to hear, but I guess I should be thankful that we are doing all we could possibly do to prevent a recurrence.

barbe1958 - Everytime I think about your treatment it breaks my heart and I get so pissed off.  We should not have to beg to receive the best chance to stay alive.  You are in my thoughts and I hope you ae able to find someone who will listen to your concerns seriously.

Sue

Thanks Sue...it breaks my heart too! I had to beg to see and onc and I saw one 7 months after surgery. She said it was too late for chemo, so don't worry about it. Doi!

Sunris, you know we'll all say we aren't docs, but I had ATHP in my "good" breast so was glad I got that one off too. Triple neg is a different beast as well. What does your surgeon say?

It is certainly true that a surgeon who is not very experienced at doing SNB or who takes nodes 'willy-nilly' could be throwing up false negative results. When I had my mast roughly 8 years ago, SNB was being trialled here in UK.I was at a hospital at first which was not part of the trial, and yet the surgeon was doing SNB.Like you, Jilly, I ran for the hills....to another hospital where they did the traditional full axilliary clearance.(Very few hospitals in UK were part of this trial at the time).I read repeatedly the the procdure is only as good as the competence of the surgeon doing it, so I am sure there must be some patients who were told 'negative nodes' when in fact they had nodal involvement.

Of course, bc cells can travel in the blood; (ie vascular invasion) - they do not need to travel via nodes to give rise to mets, though this is usually thought to be the major route (I think).

It's all a crap-shoot in the end.....

Sam

You will be releaved to know that in the 6 years since Sam heard about SNB, this has been a researched and tried and tested method.

The sentinel nodes are merely one or two nodes or so that drain from the tumour, i.e. they are the nearest ones in the chain running from that area of the breast.  It is just a descriptional name of those nearby nodes.

It isn't likely that stats can show how or by what route mets may appear elsewhere in the body, so I am noit sure how the stats could really reflect that.

In a wider sense, there is much information that suggeststhat those of us who are node postivive do have a higher rate of recurrence etc etc.

Just a little info. Pet scan are a great help in seeing enlarged nodes in the intramammary area. If you have had one then this should help ease your mind. If anything can.

Ladies there is science to the SNB. But as with all science there are exceptions. My sis' mammo, sono, mri, ct chest abd pelvis (prechemo) & Pet & MRI post chemo showed no nodal involvement. Nodes were supposedly normal on palpation. When they did her SNB they took 3 nodes but said there was no clear sentinel node (we found out later that can happen in larger tumors) all 3 were negative but her surgeon did an ax dissection as the nodes felt and looked abnormal - 10 were positive in the final path (not including the 3 sentinel nodes which remained negative). Final path also showed DCIS in the affected breast (in addition to the IDC) which never showed up in any previous studies. The nodes did show extensive treatment effect which is a hurrah for preop chemo but even after 5 months chemo (dose dense A/C & 12 weekly taxols) they were still positive (doc said active cells over 2 mm = positive) so on to radiation.

We try not to overthink it - might the cancer have spread or did the chemo blast it - if it did spread maybe the little buggers will starve once she starts Tamoxifen as she is ER/PR + like 90%. 

What does the future hold - who really knows - I could get shot by my boss for blogging at work or get hit by a bus on the way home.

 At some point you gotta do your best, trust your team and live your life. Oh yeah and pray like hell!

Best wishes to all!

I have mets, and my SNB pathology was clear.  My surgeon explained that it can travel via the lymph nodes or the blood stream.  I think they really do not know everything about breast cancer and how it works so there are many unknowns.   As Sam said, it's all a crap shoot, but the odds are very good you won't become stage IV :>  lisa

That's what it really is isn't it?  Odds.  Nothing conclusive, just odds.