Lymph Node Removal Decisions

Sugarcakes, my situation is not the same as yours (we had no reason to suspect any positive nodes beforehand, they did not show up on ultrasound or PET scan - so I was not expecting to need chemo or rads at all) but I can tell you what my docs said about the subject. My BS ended up taking out 6 nodes with the SNB. I'm not sure if that's how many "lit up" or if he could see cancer in 3 of them so took twice as many to be safe. But they knew I had 3 positive right after surgery. Later the path report said there were microscopic cells in the 4th. But both the BS and the RO told me that in the past, they would have gone back and taken the rest out, but now, they know it's just as good, maybe better, to leave them and just radiate them. So that's what we did. The rads do raise your risk of LE some, but nowhere near as much as taking them out.

sugarcakes - the goal of SNB is to take as few nodes out as possible.  If the surgeon is lucky there is a single node that lights up, but often there are several, or since nodes are encased in a fatty pad, they end up with several.  That is why you sometimes see 0/4, or 0/1, or a low number out of a low number.  In cases of a large number of nodes one of two things happened - one is that the SNB was positive in the operating room and the patient consented to ALND, and the surgeon felt this was the best course of action - either because that is their SOP, the positive node(s) removed in the SNB presented with gross disease, was extranodal, or it was clear to the surgeon that more nodes should come out based on what he/she saw, or two, they had a false negative in the OR and the decision was made to perform a subsequent surgery. It is very difficult to remove individual nodes because they are not clearly visible, and how would you pick and choose which nodes to take?  Also, each individual has a differing number of nodes - I had clearance surgery five weeks after BMX/SNB and had levels 1&2 removed, but it was only another 11 nodes.  I am a person without a large number of nodes, others could have both levels removed and have 30.  My BS, who is progressive and prudent and one of the pioneers of SNB - so in favor of removing fewer nodes, insisted on ALND due to my Her2+ status.  My MO backed him up even though this meant a delay in starting chemo and Herceptin.  The BS was correct in insisting on this for me as a sample of one, my SNB has only 20 IST - clinically node negative - but I had a much larger positive node further up.  I would not have wanted to rely on chemo and rads to completely clear a node the size of a stage 1 breast lump. A complete axillary dissection is the removal of levels 1&2 - level 3 is quite a ways up.  Here is a diagram:

I am almost 4 years out and I recall always wondering what was up with the 0/1 lymph node. My cancer was very close to my underarm and while that was great for a small scar, it wasn't that cool for lymph nodes. My BS did a SNB while I was on the table and after surgery told me all was clear. When they did the final pathology report later, they found 2 nodes with micromets out of 6 taken. It appeared my BS took a few more while he was in there. I was so caught off guard. I had my slides sent to Johns Hopkins for a second opinion since all this cancer in the nodes stuff meant chemo versus no chemo. Of course, then I found out that many doctors don't considered micromets to be a positive node. Talk about obsessing! I did end up doing the chemo and since I had a lumpectomy I did the RADS. They had to zap under my arm since that was where the cancer was and the node deal too. I ended up with truncal and breast lymphedema. It was hard to get anyone to recognize it as that. It is under control now, but not a great way to end treatment.