Sentinel Node Biopsy - before surgery?

NotVeryBrave · March 2017

So ... I was told in the beginning that I would need neoadjuvant chemo because of HER2+ and that some centers prefer to do a node biopsy before chemo is given while others just go ahead and do the chemo since that's the treatment plan. My group did not recommend any node retrieval - which I was fine with.

However, 2 lymph nodes under my arm were suspicious from the beginning on US and a biopsy was done on one. It was negative, but the radiologist put in his report that the finding was "discordant" and since that it seems like no one really trusts that it was negative.

Now I'm facing surgery decisions in about a month. And if the nodes show cancer then I will need radiation regardless of surgery type.

I'm considering asking to have the Sentinel Node biopsy done before any other surgery so that we know what we're dealing with. Has anyone else had it done separately from the breast surgery?

I thought that I had made up my mind to do the lumpectomy, but now I'm not so sure. Partly it's cosmetic reasons, but also because they found some "hypoechoic nodules" and simple and complex cysts in the other breast. :-

deni1661 · March 2017

My BS gave me the option to have sentinel node biopsy in advance of mastectomy/reconstruction. This was one of many options which made the decision difficult, so much information how do you know which choice is best. HER2 status makes it a little trickier because the end goal is to reduce chance of recurrence. It took multiple visits with the surgeon and research on my part to feel comfortable with the decision. I'm lucky my surgeons took a lot of time explaining pros and cons of each option. I need a mastectomy because I had 2 tumors far apart and enhancements on the outer quadrant. I'm 7 months into a clinical trial using just HP, no chemo and tumors are no longer visible on MRI. After much discussion with BS and PS, they felt the safest option would be to do mastectomy and sentinel node surgery with expander. I may need radiation and/or chemo if they find cancer cells so reconstruction would be at a later time.

Long story short, I didn't have the nodes biopsied separately because I still needed pathology on the breast tissue so rather than have 2 separate surgeries to find out whether I'm pCR, I decided to do it all at once.

Good luck with your decision I wish you the best. Sending prayers for complete healing. Take care

NotVeryBrave · March 2017

Thanks for your response. Wow - 7 months on H&P? When will they do the surgery?

I agree with the "too many decisions" thought. I feel very overwhelmed. I almost wish that I didn't get to choose! The RO today said that any decision will be a good one. I'm just afraid I'll have regrets. If there's any possibility that something is happening in the other breast ... I think I'd rather just take care of everything at once.

PS - I could no longer feel the lump after the first round of chemo

cive · March 2017

I had a sentinel node biopsy before surgery, but if you don't get one prior to surgery, they'll do it during surgery so I'm not sure it makes any difference. I had a lumpectomy, but now I find that when I gain weight there is a real difference in size. So you might want to think about that if your weight is not always stable.

NotVeryBrave · March 2017

cive - Can you tell me why you had it done before your surgery instead of at the same time? Was it positive or negative? And did that influence your course of radiation?

cive · March 2017

I had it done prior to surgery because my MO ordered it to determine if I would need chemo therapy. It was before the genetic testing was done regularly. Since I had a lumpectomy, I would have to had radiation in either case.

Sentinel Node Biopsy - before surgery?

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