Is it important how many lymph nodes removed?

My understanding is they can do a sentinel node biopsy then take more if needed. They actually take out a section and it varies person to person on how many nodes are in the section. One person I recall had something like 4 out of 40 nodes positive, which really surprised me so many nodes. I had 0 out of 2 positive if I remember.

Found this article

https://pubmed.ncbi.nlm.nih.gov/23578295/

Thank you, Meow. I am having an appointment with my surgeon in a couple of hours. I will ask her and post here for people to read

I had a large tumor - close to 6 cm and it had already on its own, started to cause lymphedema in my left arm, so my surgeon only did a sentinel node biopsy after injecting the dye while I was "under" for the mastectomy (I was completely freaked out about having the procedure with just a local). He took 1 or 2 sentinel nodes (reports about the number seem to vary) and there was no cancer. I told him I'd read that a sentinel node biopsy is 89% accurate and he said that yes, that is the statistic. This surgeon worked (retired now) for a major university teaching hospital and had had years of experience.

The oncologist I see works for a local cancer center that is affiliated with the university. She however, was highly disappointed that the surgeon did not do an ALND (he was trying to prevent worsening lymphedema) and noted that all of the surgeons at the cancer center would have done the ALND and that they too, also thought my surgeon had been wrong in what he did. I personally had no problem with it, as there were no other signs from scans, etc. of any spread to lymph nodes or elsewhere and I was very worried about the ALND and worse lymphedema. Both the surgeon and I decided that radiation, that I was going to have to have anyway, should take care of anything missed in the nodes.

Due to the controversy, my surgeon told me at my mastectomy follow up, that we could do an axillary ultrasound and then if anything in that looked suspicious, he could proceed further and do an ALND. He also told me there is something called a "reverse sentinel node biopsy" where they begin down in your forearm, I believe, with the dye and go "backwards" essentially, looking for any bad nodes. He said that that too, could avoid some of the complications of an actual ALND. Long story short, none of that happened, I just went with the sentinel node results, got the expected radiation, and so far, so good. It has been 4 years now since my initial diagnosis and I have had no problems. I am personally fine with what the surgeon did and offered to do if I continued to have concerns.

My oncologist continues to be "upset" over the fact that a full ALND was never done, and sometimes brings it up in a snarky way, about how we'll just never know about my actual node status, since an ALND was never done.

The surgeon, who was in his early 60's told me of how back in the day, when he first got into "the business" they would take as many as 50 and 60 nodes and that some huge percentage (way over 50%?) would develop lymphedema. Then he said a method was developed where they could take more like 20 nodes and the lymphedema development was dramatically reduced to less than 20%, I think he said. He said that they had continued that way for years and years, but that recently he was starting to see that the younger doctors were back to taking a massive amount of nodes, and he was convinced that it was unnecessary. The younger doctors just seem to want that data, that actual specific count of what was found in each node, or they remain highly suspicious that you have cancer in the remaining nodes. My surgeon on the other hand was of the "more than likely we got it all" sort of mind, and believed that the danger of lymphedema outweighed the benefit of knowing those exact numbers and fine data.

Both my oncologist and her surgical comrades at the cancer center (highly affiliated with the university that the surgeon worked for) are all in their 30's and 40's primarily, so maybe there is a generational issue here. I'll never know. I do know that all of the staff at the hospital told me that there was no question whose opinion they would go with in a controversy, and they were hands down on the side of the surgeon (many staff at the hospital had their own surgeries done by this same surgeon). Again, to this day, I have no problems with the fact that I only had the sentinel node taken and have no regrets in that regard. The lymphedema originally caused by the tumor has remained mild to moderate and very stable.

I want to faint after reading my pathology report