How to guess the No. of nodes involved when neo adjuvant chemo

When I had my modified radical left UMX last April after 5 months of AC-T chemo I had only 3 lymph nodes removed (all negative) I was surprised how few were taken out but was told by the nurse navigator that others may have been destroyed by the chemo. I didn't have a MRI beforehand so didn't have any idea if there were any suspicious nodes. There was one which was identified on the ultra sound I had before chemo bug I'm not sure if this was one of the 3 removed. This is not much help but if the theory told to me is correct (I haven't seen it elsewhere) then that might explain things. I'm choosing to not think too much about what was there before chemo/surgery/rads and to concentrate on feeling I have done all I can. As I was diagnosed with T. inflammatory breast cancer there's enough stats to worry about anyway. I did have a right UMX with my deip surgery recently. There they took out 3 nodes (all neg) with the sentinel node biopsy and found 3 more (still all negative)

I guess 3 is my lucky number!

Because of the inflammatory nature of my BC I started with chemo like you. Since my initial diagnostic ultrasound and biopsies showed an IDC 2.7cm tumor and two affected nodes, after the chemo my surgeon went for the mx and full auxiliary clearance. Post op biopsies showed 2/23 node involvement. In fact, tumors were still active in the breast lump and the two nodes, but hopefully the 25 radiations and now Tamoxifen will stop any recurrences.

So, while I know the number of affected nodes, this may not be useful in an accurate prognosis. I just know I had good treatment so don't worry about what might or might not happen in the future.

I had over 6cm of ILC and several enlarged nodes identified at initial MRI. Had neo FEC plus 8 Taxol. At mx they could only find 4 nodes matted together sized from 7mm to 2.7mm with no evidence of any cancer. Surgeon tried for another tissue sample from axilla and got 1 benign node at 5mm. Mass shrunk to 4x3x1 from 6x3.5x2.5 (initial mri- who knows if that was accurate considering it was ILC.) I also had stray foci and LCIS in all 4 quads. Bone scan was negative and PET and CAT never saw much of anything (had after 2nd chemo). In fact the CAT saw no cancer (lol- big waste of money). So..... I have asked myself the same question, how many nodes were positive..... I honestly think 3 , maybe 4 before chemo. Thing is breast surgeon said they could have been big from something else since they found no evidence of any live or dead cancer cell material. Great thing about neo is you will never really know but it's good to know the chemo is working and it helps stop the cancer from seeding which could happen more if you have adjuvant chemo.

I did both neoadjuvant and adjuvant which is different than most do. I did 4 DD A/C neoadjuvant to get the IBC to form a 'lump', get margins (IBC forms as 'nests/bands', rarely/if ever as a 'lump') and shrink so Surgeon could get it out. It apparently worked as it had formed a 'lump', did shrink and had good margins at surgery. 19 of the 19 nodes removed were positive. It was never expected to get complete response but to get to where surgery could remove it. Then did 12 weekly Taxol adjuvant to attack any stray cell that might have been 'hiding'. Then did 25 rads. It apparently worked as intended - Aug will be 6yrs since DX and I'm still NED which is great for IBC.

I know - most who do neoadjuvant will do 2 different chemos neoadjuvant and then no adjuvant. To me, it makes more sense to 'kick it's posterior' to knock it down with one type of chemo and then cut it out/get it out. Then hit with another Chemo to attack 'anything' that may still be 'hiding' somewhere. Then rads as a back up and, if appropriate, Hormonal Therapy.

Our Drs are all different (as are we) so there is no 'One Size Fits All'. My Chemo Dr is on the Tumor Board at several large facilities and he took 'me' to all, not just the local facility.

Just my experiences and thoughts.

I had a locally advanced ILC mass in my right breast.  The breast MRI put it at >8 cm.  The nodes lit up like a Christmas tree.  I was "inoperable" because of the extent of the cancer. 

Like Kicks above, I did chemo before and after surgery.  The mass had to be shrunk before the surgery could be attempted.  I did 4 TAC before surgery.  The chemo shrunk the huge mass down to <1 cm.  My surgeon was able to get good margins along my chest wall.  I chose to have a bilateral.  Even though I had a great response to the chemo as far as the mass in my breast was concerned, I still had evidence of cancer in 9 of the 29 nodes my surgeon removed.  I then did 2 more TAC followed by 30 rads and now ten years of anti-hormonal treatment.

Since the size of the tumor and the number of nodes is used for staging and subsequent treatments, I suppose it is good for all of us that we get the kitchen sink thrown at us.  We certainly don't fall into any "gray areas".