Alternatives to SLNB?

Hello NeedToChange! A year ago, I was diagnosed with IDC, with a 1 1/2 cm tumor. I had a CT scan, as well as a PetScan. Neither of the scans picked up anything in the SLN's. Thank goodness, when I had the lumpectomy, that the standard of care is to take out the SLN's. Three were taken and cancer was found in one of them. Oftentimes, the area of cancer in the nodes is so microscopically small, that it might just be some cells that have traveled there and they find them when they remove the nodes. This really determines what kind of treatment is needed as you move forward. So, in my limited expertise, I would say that CT scans and PetScans are not as efficient in finding tiny areas that the cancer cells may have traveled to. You want to catch this at it's earliest stage, instead of having it overlooked and letting it become more invasive. I hope this helps...

Imaging can sometimes see issues with cancer in the axillary nodes, but the problem with relying on it for anything other than clinical staging is that things need to have achieved a certain size, generally over .5cm, to be seen, or have uptake on a PET. It would be very easy to miss something in the nodes with imaging - otherwise more docs would be doing it instead of a surgical procedure. Doing SNB procedures aims to find cancer when it is smaller than what can be imaged, and also to minimize taking more nodes, such as in axillary dissection. The goal is to remove just one node, however, sometimes more than one is encased in the fat pad that collects the dye/tracer. Most have numerous nodes in the axilla - removal of the SNB is a procedure that is performed so that you don't have to remove more than has been identified as the first away from the breast. While there is some risk of lymphedema with a SNB, it is not nearly as common as it is with removal of all nodes in the axilla. The Newman cite from 2006 that I could find discussed SNB with core needle biopsy of the breast mass versus excisional, not core needle biopsy of the sentinel node itself. I have never heard of CNB on a sentinel - is it possible you mis-read? I could not find a cite for the other author for 2003. Maybe you could link them? My sentinel on the cancer side had 20 IST (isolated tumor cells), which is so small that it doesn't even qualify as a micromet, yet I had a much larger positive node further up which was not seen on either ultrasound or MRI done pre-surgically. If I had either skipped the SNB, or had a core type biopsy done, this could have been easily missed, in fact, it was missed in the operating room altogether and found later in the more thorough dissection in the lab. You can discuss eliminating the SNB with your breast surgeon since you are doing breast conserving surgery and there would be remaining breast tissue to do the SNB later, but I doubt your surgeon would consent as SNB is the standard of care, pretty much regardless of tumor size if you have an invasive breast cancer. There is a correlation between breast tumor size and positive nodes, but that is certainly not an absolute and to skip the SNB is a risk I would not personally be comfortable with. There are many who post here on BCO who had tumors less than 2cm and had positive nodes. Lymphatic drainage therapy is used after node removal to help facilitate lymphatic circulation, but I see no application for using it in place of SNB. I fully understand your concern about the SNB, all of this is scary, but doing the SNB provides valuable information about whether your cancer has spread and will provide your surgeon and oncologist with one of the tools they require to determine the next steps in your treatment. Good luck and wishing you the best!