Sentinal Node Biopsy Vs Dissection after Neoadjuvant Chemo

Rainy213 · September 2016

Hi all!

I am having quite a bit of a struggle with a decision I have to make regarding the lymph node part of my surgery. I had a biopsy in my breast and lymph node and both came back positive for cancer. In all of the imaging I had done it also appeared that there were 3 or so "irregular-shaped lymph nodes" which I assume means they were positive as well.

So, of course I started with chemotherapy, but my surgeon says that if the cancer is gone at the time of surgery she will stick with doing the sentinel node biopsy vs a full axillary dissection. I was wondering if others who had known lymph node involvement prior to surgery have had this done as well?

My main concern is the aggressiveness of TNBC and the fact that I am BRCA1 positive. I fear that though the cancer may be gone, it could have a higher chance of coming back in the lymph nodes because it was already there, whereas if she were just to do a full axillary dissection that can't happen.

I appreciate all your experiences and insight. Thank you!

Moderators · September 2016

Rainy213-

We can see your dilemma! We want to direct you to our Surgery forum, there are quite a few threads there re: biopsy vs full dissection that you might find helpful, and you can connect with other members who had to make the same decision.

Good luck with whichever procedure you undergo, and please keep us posted!

The Mods

Maya15 · September 2016

I had similar lymph node involvement at diagnosis and did chemo first, but my surgeon said sentinel node biopsy was out of the question and I had to have ALND. The problem is they can't tell definitively from the scans post chemo and before surgery if the cancer is really all gone or if there are still active cells. In my case (and maybe yours too) they already knew the cancer had got past the sentinel node in the first place, and if the chemo wipes out the cancer in the sentinel node there could still be some residual cells in other nodes. It turned out from my surgery pathology report that I had a complete response to chemo in the breast and the nodes, but my cancer is very aggressive and I'm ok with erring on the safe side.

rozem · September 2016

I wouldn't feel comfortable leaving those nodes behind since you had one positive and looks like several more were highly suspicious.

I would ask your RO if they feel radiation to the nodes instead is just as effective as removing. Probably less lymphadema risk that way

Redporchlady · September 2016

My surgeon recommended a full disection of all the lymph nodes. My PET scan and physical exam suggested that the chemo had gotten it all but the only way to know was to remove them all. I am glad I did and I did have 5 treatment affected lymph nodes so the chemo killed it all. They did discuss the chances of lymphedema in that arm. I am glad I had them all removed and it did give me peace of mind that I did everything I could.

Sentinal Node Biopsy Vs Dissection after Neoadjuvant Chemo

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