Do MRIs accurately predict node involvement/non-involvement?

I have, yes. The MRI showed the tumor with 4 bright spots surrounding it (the 4 spots turned out to be non-malignant), but it did not show node involvement. During surgery, 4 sentinel nodes were removed and analyzed immediately by a pathologist, who found no cancer cells present, so no further nodes were removed. A more thorough analysis after surgery showed that a micromet (about 0.9mm) was present in one of the nodes. Because of that, I had chemotherapy, when up to that point everyone expected that hormonal therapy would be all that was necessary. So you never really know until the final path report after surgery. And that report is only done on the nodes they have removed... even if those nodes were clear, it is unlikely, but still possible, that cancer cells have migrated to nodes that were left intact.

My MRI did not show node involvement, but I had two positive nodes.

I had three scans before beginning neoadjuvant chemotherapy: an ultrasound, which showed a suspicious node, a PET scan which showed a suspicious node, and an MRI which showed a suspicious node. That node was also tested via fine needle biopsy, and it was found to be cancerous. So, prior to chemo, my doctor staged me at Stage IIIA because of the tumor size (over 5 cm.) and the nodal involvement (at least one node). Hope this helps!

Hi, I just wanted to add that my clinical examination and the US and MRI imaging found no nodal involvement and that was the same result after surgery. While I was waiting for final pathology and worrying, of course, I did a lot of research. When an MRI sees no evidence of nodal involvement, it is about 80% accurate. I hung on to that during the waiting process. But as the ladies above state, nothing compares to the pathological examination of removed tissue. Good luck in your treatment and if the MRI says no nodal involvement, hang on to that!

MsP

Pik,

My nodes showed clear on US and MRI - they call it "clinically node-negative". Sentinel lymph node biospy found a 2mm micromet in one node. BS said MRI can't really dedect cancer that is under 2mm. Even with the positive node, I was not given chemo due to low oncotype score. Although the Onco test was originially only given when node negative, it is now routinely used when there are 1-3 positive nodes. However, I received radiation because of the node, so immediate construction would have been compromised. I had expanders, fills then radiation, then exchange.

Pink,

I hope someone might chime in to explain the OncoType test better than I can. It is a genetic test of sorts, done on the tumor itself. It looks for certain characteristics of the tumor, including ER, PR, her2, Ki67,and others - basically genetic characteristics of the tumor that are thought to influence recurrence. When you say "genetic test", are you referrirng to testing for BRCA1/2? That is a test done using your blood or saliva, not on the tumor.

About reconstruction, a few things. I have seen photos of immediate reconstruction and the women looked very beat up! no way to avoid that. If you end up not needing radiation or chemo, you can have the exchange fairly quickly - just make sure to ask your PS. Each one has different policies on how long to wait. My PS said at least 6 weeks after radiation. (I waited 12 weeks). Some PS insist on at least 6 months after radiation. I understand your frustratio, especially with all the strides they have made with skin-sparing mastectomy and such in the world of plastic surgery.

Come to think of it, I had my sentinel biopsy done about 5 days before my mastectomy. So I knew going into the BMX that I had a positive node. If you could do that, then you would know what other treatments would be needed and whether or not you should do immediate or expanders??

just curious, were you offered oncotype testing?

The only way to know if nodes are involved is at surgery. Not everything shows up on MRI necessarily. MRI showed I had no node involvement and my tumor was 4cm. I had 1 node involved and there was a string of cancer cells leading to a 3 cm tumor which surprised the surgeon, so I had 7 cm of tumor--it was dumbbell shaped and buried nicely.

Hey thanks diabetic.... I was given another ultrasound for my lymph nodes and did not get the same doctor that had been giving me ultrasounds. So, I got another doctor who did not look at my pathology report but did look at my MRI scans and the ultrasound scans and gave me a morbid review of my prognosis. I knew he didn't look at my pathology report because he couldn't tell me details about it ( I had to tell him). I thought it was un called for for him to give me bad news that I already knew about. His tone of voice was morbid. I was so upset after leaving. I hope the oncologist I see on Tuesday about chemo gives me better details about my prognosis.

Hang in there, Christine7. Indeed, be thankful that you didn't wait until age 40! Once you know more, you may want to jump into another, more specific forum, including that for younger women. We are truly sorry that you find yourself here, but hope you find comfort in our community, and know you are not alone!

Hugs,

The Mods