After breast surgery of any kind, the lymphatic system is disrupted, making it challenging to find the sentinel node. With my recurrence, they were not going to even look for it, but I had a second opinion consult at Mayo where the surgeon there was doing research on using the dye and radioactive injection, and they were having about 50% success, which is greater than previously thought by surgeons other places (who usually did not even try). I could be off on her percentage; my notes are not in front of me. Based on that consult, my local doc (I went local due to no family in the area to help if I traveled.....and that the local surgeon knew exactly where my cancer was) did try to find the sentinel node. He was not able to, but in the process of trying, he did find another tumor which had not shown up on ultrasound or MRI. So...... it is worth them trying to find the sentinel node, but because of previous disruption, they just may not be successful.

It looks like they took out the suspicious node, and it was negative; it just may not have been the "sentinel" node. The path lab labeled it negative. It was called the sentinel node most likely, because that's what's usually sent. You should definitely clarify with your surgeon. Also, make sure they've done imaging to take a look at the nodes, even though it is not perfect.

I did have the dye injections before surgery to ID sentinel node. It was found easily and was negative with good margins around lumpectomy site in 2012. My lymph nodes everywhere appear negative in all scans since early 2018 but I'm metastatic in lung and bones. No breast recurrence. Go figure. I agree each case can have anomalies that are frustrating and hard to put in a neat box. Do ask to help resolve as many questions as possible but some can never be known. Hugs and peace for your day

Donna, it sounds like a seroma

The day before my surgery I had the radioactive dye injected and the tech made Xs on my skin with a Sharpie where I 'lit up'. The following day for the lumpectomy the surgeon injected the green dye to locate the nodes. When she spoke to me after the surgery, she said that nodes are normally in a known location PLUS I had Sharpie Xs on my armpit, yet nothing showed up that was green and looked like a node. So she cut deeper looking for a node. And cut deeper still. She found ONE node that she felt was indeed sentinel, but was sure pathology would be unhappy with only one node, 3 or 4 being the norm. She was not happy but said "I quit cutting when cutting any deeper was a really bad idea." (I have some pretty obnoxious lymphedema for having one, lousy node removed!).

My Onco score was 11. I was initially jubilant. But considering that the first pathology report said grade 1, stage 1, and the second upgraded me to a stage 2, grade 2, and only one node was sent off .... I feel uncertain all the time. I did not chemo. I am on tamoxifen. When I read Joe777 and getting mets with her low Oncoscore, it scares the hell out of me. So yes, some of us seems to have a shortage of nodes or they have gone into hiding. But I only had one to send off and it showed no evidence of disease.

runor - where does Joe777 say her Oncotype score was low? Its not a foolproof system anyway but my score was also 11. I had IDC Stage 1b, Grade 1 and will be 8 years out this August God willing.

Diane

https://community.breastcancer.org/forum/62/topics/870892?page=1

Runor, you're not going crazy. I only remember this thread because it intrigued me and Joe777 lives in the Houston area.

Nicole, glad to hear that you will be with your first choice.

Spoonie, here are two versions of the Oncotype report that I found on-line. I've put in a red arrow to highlight the metastatic risk figures on each chart.

Version 1:

Version 2:

And here is a chart from the Appendix of the TAILORx study that shows their findings on metastatic recurrence risk by Oncotype score, for those who take endocrine therapy only versus those who take chemo + endocrine therapy. The top chart is for those age 50 and under, and the bottom chart is for those over age 50. The solid red line is endocrine therapy only and the solid blue line is chemo + endocrine therapy. The red line is only shown up to a score of 25 because those running the TAILORx trial made the decision that everyone with a score of 26 and higher would get chemo in addition to endocrine therapy. So there are no results available above a 25 score for endocrine therapy only.

One thing to be aware of is that some Oncologists have an additional computer program from Genomic Health that further refines the metastatic risk estimate based on the Oncotype score combined with the age of the patient, the size of the tumor and the grade of the tumor. This is called the Oncotype RSPC (Recurrence Score - Pathology Clinical). This tool might provide either a lower or higher recurrence risk estimate than the standard Oncotype report for those with favorable (older, small tumor, lower grade) or unfavourable (younger, larger tumor, grade 3) characteristics, and this could affect the chemo vs. no chemo decision, as it has for a few people on this site who've mentioned their MOs using this tool.

Thank you Beesie - I realize that the risk of mets will never be zero. I feel uneasy often about my upgraded pathology report (from grade 1 stage 1 to grade 2 stage 2) and that only one node was found. My surgeon seemed optimistic. My Oncologist as well. I'm a bit more skeptical. (Oncoscore 11)

runor, I certainly understand your concern. And I understand questioning whether you should be doing more. But with an Oncotype score of 11, as my earlier posts explained, there would be no benefit to chemo and you might actually put yourself at greater health risk if you were to have chemo. I don't know enough about how the Oncotype test works to know if there would have been any difference in your score if you'd had more nodes checked and 1 or 2 had been positive. I don't think so, however. Since the Oncotype test analyses the genes within the tumor (and does not do an analysis on the nodes) and the tumor would be the same regardless of the nodal status, I doubt that there would have been any difference in the score or the recommendation that chemo would not be beneficial to you. Your tumor is genetically favorable and low risk and that wouldn't change even if your nodal status changed.

Given your 11 score and your questions about nodal status, this meta-analysis might be reassuring to you:

Clinical relevance of the 21-gene Recurrence Score^® assay in treatment decisions for patients with node-positive breast cancer in the genomic era

The conclusion: "the evidence we have summarized is consistent across retrospective-prospective, prospective, and registry studies and shows that patients with N+ breast cancer and a low number of positive nodes who received hormonal therapy but no adjuvant chemotherapy have highly favorable outcomes if they also have low RS results."

Pereginelady, as I mentioned to runor, since the Oncotype test analyses the 21 genes in the tumor and does not look at the nodes, I doubt that your score would have been different - but I don't know this for sure. However, there is a different scale for Oncotype scores for those who are node positive vs. those who are node negative. So the same score would translate to a different recurrence risk. That said, I believe that with a 12 score, chemo would not be recommended even for those who are node positive. Have you talked to your MO about this? It would be interesting to hear what he or she has to say.