Question on SNB during lumpectomy

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etnasgrl
etnasgrl Member Posts: 650
edited December 2015 in Surgery - Before, During, and After

I see that some ladies who have a SNB during their lumpectomy find out right after surgery if the lymph nodes were clear, while others have to wait to find out.
I know that they run a pathology report to determine if the margins are clear, but do they also do a pathology report on the lymph nodes or can they tell by looking at them if the cancer has spread or not?

I'm sorry if this a dumb question, I guess I'm still learning and trying to figure things out.
I do know that my surgical oncologist told my husband that she only took one lymph node, as she felt that was all that was needed.

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  • Molly50
    Molly50 Member Posts: 3,773
    edited December 2015

    During my surgery my snb got sent to pathology first while my surgeon continued the surgery. Pathology came back positive so she removed the level one nodes for a total of 9. She also had the pathologist check the margins before she finished.

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  • Molly50
    Molly50 Member Posts: 3,773
    edited December 2015

    To add more information, the lab will do a full pathology report on your tumor, nodes and margins.

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  • mustlovepoodles
    mustlovepoodles Member Posts: 2,825
    edited December 2015

    My BS sent the two sentinel nodes off to pathology before she closed things up. The initial path report was clean, so they finished up and sent me home. The pathologist also sent the node tissues out for a second opinion, which also came back okay. That's pretty standard procedure.

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  • BarredOwl
    BarredOwl Member Posts: 2,433
    edited December 2015

    Hi:

    The number of nodes removed depends on your personal anatomy, and is typically from one to three nodes. I had four sentinel nodes on one side, and one sentinel node on the other.

    The sentinel node(s) are examined during surgery (intraoperatively). My institution used the standard hematoxylin eosin ("H&E") staining, and the nodes were completely negative by that criteria.

    After surgery, the node tissues are examined again by the pathologist along with the other tissue removed. Hopefully, it will confirm what was seen during surgery.

    Sometimes the sentinel node tissue is evaluated by additional detection methods post-surgery, such as immunohistochemistry (IHC) or less commonly by reverse transcriptase polymerase chain reaction ("RT-PCR"). These additional methods are not always indicated or performed.

    BarredOwl

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  • savgigi
    savgigi Member Posts: 376
    edited December 2015

    My surgeon said unless the nodes had something visually wrong, it would be difficult for pathology to to examine the entire nodes for cancer. They were tested with the breast tissue and I got the report at the same time. I guess the practice differs at different centers.

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  • LisaAlissa
    LisaAlissa Member Posts: 1,092
    edited December 2015

    There are no dumb questions (except the ones that don't get asked!). The final word is the final path report. Anything before that (including during surgery or any interim path report before the final) isn't final! So I was holding my breath until the final path report was back on my SNB.

    Just a "heads up." If the number of nodes in the path report is different from the number in the surgical report, definitely inquire. But don't panic.

    Your surgeon said they only took one lymph node...but your pathology report might talk about a different number that they examined. I was told that it wasn't always easy to count lymph nodes. The surgeon counts based on what they see in the physical anatomy (and how the dye/radioactive tracer used spread) during the surgery. But the pathologist counts based on their microscopic views of the anatomy of the sample they received. So it isn't at all uncommon for them to be talking about different numbers of nodes.

    Here's hoping all of your reports have the best news possible!

    LisaAlissa

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  • Nancy2581
    Nancy2581 Member Posts: 1,234
    edited December 2015

    My BS told me they don't examine the nodes in the operating room anymore. There have been times where the nodes were said to be clear and then when pathology came back cancer was found. Soooo I had to wait to know anything.

    Nancy

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  • BethL
    BethL Member Posts: 286
    edited December 2015

    the initial tests on the nodes is just preliminary, to determine if more nodes need to come out. There's always a chance they'll end up being positive in the final path report. My 4 were negative during surgery and a week later the final path confirmed it. Docs don't want to remove a ton of nodes unless it's necessary.

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