questions about lymph node biopsy and treatment

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Hasta
Hasta Member Posts: 7
edited March 2021 in Just Diagnosed

Can anyone answer the following questions?

1.) In the profiles many have a designation about their lymph node (i.e., 0/3). Does that example mean three nodes removed none positive?

2.) I pointed out to the radiologist a slightly enlarged lymph node in my lower armpit so she biopsied it. The pathology report listed that it's positive for isolated tumor cells and the largest metastatic deposit measures 0.04mm, negative for extranodal extension. I read in another post that an axiillary node isn't considered positive until it's 0.2mm. Can anyone shed some light on this? My MRI also showed one more node with "abnormally thickened cortices."

3.) I do understand the process of SN testing during MX surgery but I'd like to know what your personal trade-offs are for surgically removing the nodes versus having proton radiation for positive nodes. I sight the article below for showing the latest research on the subject. I didn't know radiation was was a option over surgery for lymph nodes after reading the following article. Note: I wasn't able to post the link but the article is from this breastcancer.org

Lymph Node Radiation, Surgery Offer Similar Outcomes After Positive Sentinel Node in Early-Stage Breast Cancer


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  • Beesie
    Beesie Member Posts: 12,240
    edited March 2021

    1) Yes, you've got that right. 0/3 means that 3 sentinel nodes were removed and none were positive.

    2) Yes, 0.04mm would be considered Isolated Tumor Cells (ITC) which officially is considered node negative, although an asterisk is included to note that there were ITC. On a pathology or staging report it would read as pN0*

    Did you have a needle biopsy on the positive node? If so, the amount of cancer pulled up by the needle might not be all the cancer that is in the node. The needle only retrieves a sample and the entire node needs to be removed and analysed under a microscope.

    3) The study you referenced and the concept of having radiation to the nodes rather than node removal refers to what is done after a positive SNB, when the other option (vs. radiation) would be a full axillary node dissection. It is not suggested that radiation be done in lieu of having an SNB. As I mentioned above, a needle biopsy to a node only provides a small piece of the picture and does not replace the need to have an SNB. Based on your needle biopsy, you only have ITC. The SNB might confirm that or it might show more extensive nodal involvement. This could have a significant impact on your treatment plan. The SNB is necessary. Beyond that, your medical team might recommend, and/or you may choose radiation instead of an axillary node dissection.

    Hope that helps.



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  • LivinLife
    LivinLife Member Posts: 1,332
    edited March 2021

    Hello Hasta! 1) Yes I see you just chimed in here Beesie - as I was scrolling up to read the remaining questions... Whew - you got this! #2 and 3 out of my league.... I will wish you well Hasta! Good for you for doing your due diligence as you consider your options.... Please keep us updated as you move forward all right? Best!!

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  • LaughingGull
    LaughingGull Member Posts: 560
    edited March 2021

    Hi Hasta,

    Your questions are questions for the surgeon. But the "surgery for lymph nodes" referred to in this study is a full axillary lymph node dissection, not a sentinel lymph node dissection. They compared:

    1. Patients who had breast surgery (usually including sentinel node biopsy SNB, with one or a few nodes removed) plus radiation
    2. Patients who had breast surgery plus full axillary node dissection (ALND, with the entire axillary fatty pad and all axillary nodes level I and II removed) and no radiation

    And they found that, after 10 years, the outcomes were similar.

    Given that you have one node biopsied positive for cancer, you will have nodes removed during surgery, for sure. When I had my surgery (I also had a node that biopsied positive beforehand), the recommendation was a full axillary lymph node dissection; I talked to two different (top) surgeons, and they were both adamant about that. So you may not have the choice of having *just* a sentinel lymph node dissection -they may recommend a full lymph node dissection.

    The pathology report that counts is the one obtained from surgery, that will give the final picture of size of metastatic deposits and extranodal extension.

    Here are the links explaining the full node dissection vs sentinel node dissection in this same website:

    https://www.breastcancer.org/treatment/surgery/lym...

    https://www.breastcancer.org/treatment/surgery/lym...

    LaughingGull

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  • exbrnxgrl
    exbrnxgrl Member Posts: 12,424
    edited March 2021

    laughing gull,

    The op has only isolated tumor cells. That is not considered node positive and as beesie noted, a sentinel node biopsy would need to be done before other decisions need to be made regarding further node removal.

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  • LaughingGull
    LaughingGull Member Posts: 560
    edited March 2021

    My point is that she is never not getting, at least, a sentinel lymph node dissection. She seems to be under the impression that one can opt out of having any nodes removed if one is going to get radiation. That is not the conclusion of the paper.

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