DCIS - Question on Requesting a SNB w/Lumpectomy Surgery

If you have a successful lumpectomy with wide uninvolved margins and nothing but DCIS found, I think you can rest easy that there is no node involvement. If some invasive cancer is found, then you can think about checking nodes in a subsequent surgery. Given that your DCIS is low grade, invasion is unlikely. Pure DCIS cannot spread to the lymph nodes. Scan through the DCIS threads and notice how many people had SNB with nothing found. My tag says "0/2" meaning that none of the two lymph nodes taken in my mx contained cancer. We can be sad & frustrated about a lot of things, but we can be thankful for this! Best wishes!

I was diagnosed with IDC from the excisional biopsy.  My treatment consisted of lumpectomy and SNB.  When the final path came back there were wide clean margins and also in the middle of the lump he removed was a "speck" of dcis.

I had 35 rads that I finished in January and have been on letrozole since then, with few SE.  I'm glad I had the SNB since I was kinda antsy thinking about lymph node involvement but there was none. 

I had an "old lady cancer" according to my surgeon.  He said that most older women (I'm 56 so they really must be old, lol) had the type and grade that I have, stage 1 & grade 1 IDC.

I have an appointment for my first post diagnosis mammo next week so I'm kinda getting antsy about that but am praying to hear "all clear".

If you are questioning the lymph node issue, please talk to your surgeon and let him or her be aware of your concerns.

Take care,

LaDonna

Node removal is not needed for DCIS, particularly if someone is having a lumpectomy and an SNB can be done later, if it turns out that invasive cancer is found.

So I will second what BLinthedesert said.  It is to your advantage to avoid an SNB. It may not seem that way to you now, when your focus is on your upcoming surgery and your recent diagnosis. But longer term, once this diagnosis is in your rear view mirror (which really won't be that long from now), you will have a different perspective.

Removing even just one lymph node opens you up to a life long risk of lymphedema.  And if you get lymphedema, you have it for the rest of your life. This is not a risk that you want to expose yourself to unless it's necessary. 

A tiny amount of low grade DCIS is very unlikely to be hiding any invasive cancer. But if it turns out that some invasive cancer is found, then you can have the SNB as a second surgery. Yes, requiring a second surgery would be the pits, but with your diagnosis, the odds that this will be necessary are very low. And personally I think it's a much better option than having the SNB now with your lumpectomy and facing the risk of lymphedema for the rest of life, most likely for no reason at all (if your final diagnosis is pure DCIS). 

I had an SNB - no choice about it because I had a microinvasion of IDC which luckily was found during my excisional biopsy.  I hate that I have to be so careful with my arm - no blood draws on that side, no blood pressure, I worry about infection every time I get a cut on my hand and I really worry if I get a cut while shaving... those are the standard precautions and concerns of anyone who's had nodes removed. 

Hi NSJ2 -- you can't have any future radiation treatment in the breast that has had any past radiation (internal or external).  There is a woman here on the boards named "Shayne" if you search on her name you will find her.  She had 5 day internal radiation this summer, I am sure she would be happy to answer any questions you have about this; I am sure there are more women on here who have been able to go that route, I just don't know them personally.  Had I been given that option I would have taken it!!  I think the largest benefit is the time issue -- 5 days versus 5-7 weeks - every weekday (doesn't take much time to get "zapped" but it does add up in terms of time to get to the center, etc.).  You should look through the "getting through treatment - radiation" threads ... so much information, and a really really good group of ladies.  "My" group was the May 2012 group ... any one of those ladies would be a good resource for you.

Best wishes for a speedy, and uneventful, treatment! 

Good luck! 

Oh my goodness! I just re-read my earlier post - I certainly didn't mean to say that your diagnosis will change! A VERY bad typo indeed. My deepest apologies. I'll re-read my posts more carefully in future!

For patients who meet the criteria the choice of whole breast irradiation vs. brachytherapy or other partial breast irradiation is up to the patient.  Many patients do not meet the criteria and physicians vary in how strictly they apply the criteria. 

I would be cautious about basing a decision on type of radiation solely on a surgeon's recommendation.  Ideally you want a tumor board or other consultation among the different specialists that allows all of your factors to be considered. 

The following article describes guidelines from the major professional society of radiation oncologists for Accelerated Partial Breast Irradiation (APBI) based on the data available. Brachytherapy is one method of doing APBI.

http://www.sciencedirect.com/science/article/pii/S0360301609003137

Criteria for being "suitable" for APBI include patient age >= 60 years old, no BRCA 1/2 mutation, tumor size <= 2 cm., Stage T1, margins negative by at least 2 mm., no lymph-vascular space invasion, ER+, unicentric only, clinically unifocal with total size <= 2 cm., invasive ductal or other favorable histology, not pure DCIS, no extensive intraductal (i.e. DCIS) component, pathologically node negative, sentinel node biopsy or axillary lymph node dissection. The article goes on to loosen some of those criteria in defining a "cautionary" group for whom APBI may be considered, as well as a group of patients for whom APBI is "unsuitable".

Some radiation oncologists are more favorably inclined toward APBI than others and use of these guidelines, especially for the "cautionary" group, will vary.

hi NSJ2. DCIS is not invasive so shouldn't need SNB , but some surgeons insist on it. I have to have simple mastectomy for my DCIS because it is in more than one place, surgeon is insisting I need SNB as well don't understand it ? You know that there can be soreness under arm after SND. Think about it if your surgeon is not saying you need it ,talk to him or your breast nurse first.

Alfieval - the reason they want you to have a SNB is, as was mentioned in your other thread about this that it cannot be done once you have had the mastectomy.   You are correct in that there is no need for it if the patient is known to have pure DCIS, but that can't be known until ALL affected tissue has been removed and examined.   Since there is a small (20% is what I've seen) chance that the patient might not have pure DCIS, but have a hidden component of IDC, they usually recommend that DCIS patients having a mastectomy also have a SNB because it can't be done after the fact and the thinking is better to have done it and not need it, than to need it and not have done it, since the other choice would then be to remove ALL the lymph nodes, which has a much higher risk of complications including lymphedema.

For patients such as myself who were known to have a micro-invasion of IDC prior to the lumpectomy, a SNB is also recommended.   For patients known only to have DCIS who are having a lumpectomy, they usually do not recommend a SNB - this is because should the patient turn out to have an invasive component, unlike with a mastectomy, following a lumpectomy it is still possible to go back in to identify and remove the SNB.

I understand the worry, but although there is a risk, it is usually pretty small.     I had 3 nodes taken out 18 months ago, and so far (knock wood) no problems.   My mom had a mastectomy at age 75 with 1 node taken (about 6 weeks before my surgery) and so far she is doing just fine.