Sentinel Node Biopsy?

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Anonymous
Anonymous Member Posts: 1,376
edited June 2014 in Lymphedema

Hi ladies,

Ive just been posting to a lady on our NZ forum who said she had a SNB and I wasn't sure what the implications are if any, in regards to LE risk. Could someone chime in on this please.

Thx

Musical

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  • carol57
    carol57 Member Posts: 3,567
    edited May 2013

    Musical, the LE risk after snb is low, but it's there nonetheless. Studies vary so much (number of people in the study; follow up period after surgery; how they define 'LE' meaning what measurement criteria they use; how they measure-what method) that the study results are not at all consistent. 5% to 18% is the range I've seen on risk of LE after SNB. That's such a whopper of a range, the problem is study inconsistency, and to me it means taking LE precautions seriously.  You know--all the 'protect' and 'promote' suggestions on stepup-speakout.org.  I hope you're suggesting that site to the lady on the forum!  If her surgeon said risk is so low as to not worry, I say phooey!  That's exactly what my surgeon told me when we were deciding on snb, and well...here I am.

    Carol

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  • Anonymous
    Anonymous Member Posts: 1,376
    edited May 2013

    Yiiikes so you didn't have any nodes out and here you are !?!? Cry

    Thanks Carol, and I will recommend SUSO, but I'll also link her here. I know this sounds stupid but I didn't even know, or in all my reading it just hasnt registered that they only did biopsies of nodes. I'll just put it down to info overload, and not enough music in the interim. LOL...

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  • Anonymous
    Anonymous Member Posts: 1,376
    edited May 2013

    OK I have never really considered the acronym SNB until now. Probably because I never had that. Please set me straight someone.... a SNB is a removal of the sentinel node?  My confusion has come because in my mind a biopsy is a sample of something not a removal.

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  • Ariom
    Ariom Member Posts: 6,197
    edited May 2013

    Hi Musical.

    Yes, SNB  is the removal of the Sentinal Node, the one closest node to the tumor.

    I had mine the morning of my Mx surgery. The tracer is injected, and then a scan is done to make sure the tracer has been taken up by the node. During surgery the node is removed after being found with a geiger counter type instrument.

    It is done with a Mx because after the breast is gone it is impossible to do a SNB

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  • GuyGirl
    GuyGirl Member Posts: 182
    edited May 2013

    I had a lumpectomy and a SNB at the same time and did not develop LE until 2 years out but it went undiagnosed for about 6 months before the lightbulb went off in my head.  My first symptom was a painful mamogram in November, It did not dawn on me at the time that LE was causing the pain.  It was not obvious to me until my hand started to swell.  I have two bad discs in my neck and thought my arm pain was from that.  Go figure.

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  • carol57
    carol57 Member Posts: 3,567
    edited May 2013

    musical, I did have nodes removed.  At the time of my bmx, I had a sentinel node biopsy that removed 5 nodes. SNB is, as Ariom said, a removal of the node closest to the cancer or suspicious lesion. Only sometimes the tracer dye lights up more than just one 'sentinel' node, which is what happened to me and is quite common.  I also lost one identified node in the breast on my non-SNB, non-LE side, which is also quite common.

    Some people are simply pre-disposed to LE, and there's a growing body of research to suggest that there's often a genetic component to the disease. Other research is finding that the disease is systemic, i.e. symptoms show up and we think it's 'just' the arm or truncal area after say, node removal or rads, but lymphoscintigraphy (imaging) shows compromised lymph transport in the unaffected arm.  That may explain why some women develop LE on the other side of their node removal after months and years of MLD moving fluid to the other side--the other side already has some lymphatic deficiency, and the MLD overloads it. That's conjecture at this point, but worth discussing with LE therapists who might think about moving lymph downward toward the groin area instead of across the body.

    The science of LE is progressing.  Too bad they're still working on understanding the cause, with very little research seeming to be focused on the cure!  I guess understanding the cause may lead to prevention methods.  We can only hope.

    Carol 

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  • boobookitty
    boobookitty Member Posts: 21
    edited May 2013

    I had sentinel node biopsy that removed 7 nodes.  No one discussed or said one word about lymphedema to me before the surgery.  I had read about it on-line myself.  When they got me to my room I had a sign behind my bed and also a pink wrist band on that said Restricted Extremity.  My daughter was telling me about the sign and asking why.  Then the nurse talked to me about the risks and let me know to never have blood draws or blood pressure on my right arm.  It was a odd feeling to keep having them check my blood pressure on my left arm which had my IV in it for the two days I was in the hospital. 

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  • carol57
    carol57 Member Posts: 3,567
    edited May 2013

    boobookitty, you had a great response from your hospital care team. I had to argue my way to arm precautions and to make them move the BP cuff from my SNB arm to the other arm.  They literally had that thing on the wrong arm all through and after surgery. And this was a well regarded teaching hospital affiliated with a major university in a huge city.  My BS said that in her practice, nobody gets LE after SNB, and I guess she thinks that's so true that no arm precautions are needed.  I'm glad you had a much better experience, but you are right that more should have been explained well beforehand. This is such a common theme in this forum!

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  • Binney4
    Binney4 Member Posts: 8,609
    edited May 2013

    Musical, ANY trauma to the breast/chest area can result in a risk for LE. I had a single node removed on the affected side (left) and no nodes removed on the other, prophylactic side, and I have bilateral LE. People who are involved in car accidents where they hit the steering wheel can get LE, and football players sometimes suffer from it. It's common after earthquakes because of all the crush injuries that people sustain.

    As Carol explained, there's a very real risk for arm LE following SNB, and a heightened risk of breast/chest LE following SNB/lumpectomy with rads. Nasty business. Too many doctors have their heads in the sand.

    Greet your NZ gal for usSmile,
    Binney

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  • Anonymous
    Anonymous Member Posts: 1,376
    edited May 2013

    You ladies are all BRILLIANT! Thankyou so much for explaining this. One thing I've learned is how many "simple" things like well known procedures which can slip us by when we havent done that particular procedure ourselves. This is a prime example for me.

    Also, as I think a concise list with just a basic explanation of everything involving BC would be a wonderful resource for not only newbies but all of us, recently I posted to the Mods down the bottom of the forum about an old thread which had an alphabetical list of all the acronyms etc we BC people encounter. I couldn't for the life of me find it but it is here : (it's a list we can all ask the mods to update if we know of any that arent there...and Im sure theres some right here with us LEers )

    http://community.breastcancer.org/forum/131/topic/773727?page=1#idx_1

    I had a quick look at wikipedia from a google search and the word biopsy pretty much means a sample (portion) of something, so thats why I got confused. Now you guys have put me right I'll most certainly pass it on. Thx.

    Musical

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  • purple32
    purple32 Member Posts: 3,188
    edited May 2013

    Musical

    Additionally, many ppl ( even DRs!) seem to think  ONLY those who had rads will get LE.  I can understand this because  soooooo many ppl. do routinely have radiation with any BC surgery.

    I had  simple LX, with  SNB ( 2 clean nodes) and NO radiation at all.  I have breast/truncal and arm/hand LE.

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  • Anonymous
    Anonymous Member Posts: 1,376
    edited May 2013

    Purple, well, as I always say, wouldn't it be nice to have some consistency!  From memory, I was told RT didn't pose a risk or it was so minimalized as to "not worry". In fact I believe RT either caused mine or at the very least tipped the balance in that direction. I was fine until after RT. BUT having said that, like so many of us, we have other things throwing a spanner in the works to muddy the waters. Other issues, like fluid retention pre BC.

    I think the recent studies you ladies have put up have been great, and very helpful to understanding all that is LE.

    Those of us only too familiar with LE know: We NEED NO TUITION on how horrible it is.

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