Sentinel node is positive

Hi Joyce,

My surgery was 3 years ago, and had lumpectomy and Sentinal node biopsy. After the surgery I was initially told the sentinal node was good, however a week later more pathology came back to say the node was positive.  As they did not get clear margins plus positive sentinal node, I went back for more surgery and had a total of 30 nodes taken out plus to get clear margins.

That was 3 years ago, and from a lot of information I have read recently, some doctors are now opting not to do auxillary clearance of nodes as stats are  apparently saying that it does not appear to give us any better outcomes with the auxillary clearance, plus it can also start the lymphadema problems which I do have.  I believe they are saying that the chemo will sort out any problems without taking further nodes.  I believe the auxillary clearance was just another tool for them to work out your staging.

Try not to worry too much, I know the waiting is the worst, however I am sure your onc will sort it all out for you.

ched

i had double mx, sentinal node biopsy, came back negative, 1 week later, sentinal node was positive---micro-mestasis----6 weeks later, 19 axillary nodes out, all negative.Long before my double mx, i imagined my cute yet sadistic good cells smiling while holding machine guns in my armpit and fighting off the bad cells. I invisioned my sentinal node as a glorious, brave, female warrior. It worked for me. She kicked ass. She saved me.

Please use the warrior, please! It helps! Best wishes to you!

JOYCE...I was diagnosed in December... had my lumpectomy and sentinel node removed.... at surgery time, the node was considered negative, but a week later I found out I had a .38mm micromet... I did have clear margins on the tumor. I think the clear margins or lack thereof would be of more concern... I have heard that they can go back in and try and get better margins. Based on what you said, it isn't a clear cut case. I would ask about that. I have a friend who had two lumpectomies and then mastectomy in search of the clear margins...."clear enough" would bother me.

As for the nodes, I asked about having more out and my surgeon said that with a MICROMET, there was no need... that she was 99.9% sure that my other nodes were clean... plus my sentinel node had a second node attached to it and it was clean. How much was your sentinel node involved? If the involvement is less than .2mm, that is considered as basically negative... .2mm - 2mm is considered micromet... above 2mm is considered positive.

I am doing chemo to MAKE SURE no little cells escaped, so maybe that is enough for you too.  I know lots of people who have had complications from the node dissection 

Joyce, my bs said the newest studies have shown with a lumpectomy/radiation and less than 3 positive nodes the results were the same for just taking the affected nodes and doing a complete dissection. Since I have 2 positive nodes she said no more surgery,



I would want positive enough defined, again my experience was there was one margin with a tiny amout of cancer but since it was over 2mm from the edge it was considered clear.



I hope this helps.



Jean

My sentinel node was positive (micromet) and that was all they took and said no need to go back

Joyce, my sentinel also contained a micromet (0.25 mm).

btw, more than 0.2 mm(which about 200 cancer cells I believe) and less than 2 mm is considered a micrometastasis.

My surgeon said radiation might be required if they considered my node as positive. She suggested we go for another surgery and remove 10 or more, and if they all come back as negative radiation won't be required. With micromets, there's a 13% chance that cancer might be present in other nodes as well, but with additional removal, there's also an increased risk of lymphedema (about 10% increase). Furthermore, if more than four nodes came back as positive, I will have radiation for sure, which will then double the risk of lymphedema (total increase of 20%).

I opted for additional surgery, mostly for my peace of mind...

bdavis, they didn't come back yet, I only found out about it and made a decision yesterday. My surgery will be next week.

Part of what influenced my decision was that I had some drainage issues after my BMX couple of weeks ago, and the area needs to be re-opened and cleaned out. Might as well do it all at the same time. 

You're right about general opinion being not to take more... I've been doing some reading on the internet, and that seems to be a general concensus anyway...

Sloan-Kettering has come calculators for positive non SNL predicability, but its only applicable if sentinel node is simply positive, not for micromets.

minxie, I think Ia and Ib classifications must be fairly new... or maybe it depends on the actual size of micromets, but by this definition you would be Ib.

http://www.cancer.gov/dictionary/?CdrID=684439 

Joyce,

Here is the link to the study

 http://oncozine.ning.com/profiles/blogs/asco-2010-removing-axillary

mks - thanks for that info, it does make me feel a teeny bit better to be officially a 1 rather than 2. Of course since I'm triple negative it really makes no difference - chemo-wise they threw everything and the kitchen sink at it, and then I had a BMX afterwards.