Sentinel Node Biopsy

Roxi1 · January 2005

My surgeon briefly stated, after my last visit; that after my lumpectomy on 1/5, I probably would need a sentinel node biopsy if the cancer was invasive as indicated by the surgical path report. I have researched this biopsy in great depth, and understand the benefits, and what a miracle this has been in many women's lives. However, my girlfriend has told me the worse part of her biopsy was the pain she endured from the radioisotopes pre-op. She consider her trip to Nuclear Med, the 'trip to hell'. I haven't found anything conclusive in the lit, nor on line. Can anyone tell me there experiences in Nuclear Med, and what they did to cope.
thank you very much for your advice.
Roxanne

inkblot · January 2005

Hi Roxanne:

What I did to cope was act ugly! LOL My radiologic injections, done prior to my lumpectomy, were painful but not unbearable. It took me by surprise as neither my surgeon nor the radiologist who did the injections said anything indicating the level of pain I could expect with the procedure. (you should mention your friends account of her experience to your surgeon and ask him/her about it)

My experience went like this: Morning of surgery, I was lying in the preop bed, talking with my husband. Had not yet received any medications. In comes the radiologist with a big smile. She explained that she would be doing 3 injections and pointed out where, each going in precise areas around my tumor, and that I'd feel the needle stick, followed by some pressure. She proceeded. The needle stick was no big deal but just seconds afterward, the feeling was far beyond "pressure". It was painful. It began with a slight burning sort of feeling and quickly became outright pain. As I responded to this, the radiologist (and her observer who was in tow), both looked at me as if I'd become the proverbial bug under the microscope! I believe my verbal response was something like: "Damnation this hurts, why didn't anyone tell me what to expect"? (the pain wasn't enough to cause me to swoon, however I was highly annoyed because I had not been properly informed) Although the radiologist seemed genuinely sympathetic and repeatedly apologized, it didn't help much really. The good news, at least in my experience, was that the pain only lasted about 10 minutes and began to dissipate. Then I felt only the pressure I'd been warned about. (I had both the dye and the radioactive tracer injected...some docs prefer one or the other while some prefer both, so whether one has "one or both" may play a role in the level of pain?)

I told my surgeon at my follow up visit, several days later, about the level of pain and he said that he was so sorry and that he would make it a policy to better prepare his patients in the future, etc.. He said that some have major pain while others have less. Since they see and acknowledge the pain most seem to experience during this procedure, are they ignoring it or have they assumed the "ignorance is bliss" approach?

My thought is that there's really no way to avoid the pain, otherwise something to lessen the pain would surely be utilized. Like everyone else, I fare far better when I'm prepared and know what to expect. (I typically prepare myself with some meditation and relaxation techniques and do quite well with most painful procedures) With this though, I was unaware and unprepared. Not a fair playing field to say the least.

As an aside: I don't know anyone who has had the sentinel node procedure, post lumpectomy. It's typically done at the same time as lumpectomy. Doctors have different philosophies though. Am wondering what other surgery you've had, prior to your upcoming lumpectomy? My thought is that since your initial surgical path report indicates invasive cancer, then why not do the sentinel procedure at lumpectomy? Once your tumor is removed, how could where it's draining be reliably mapped via sentinel node? Seems to me that if the tumor is gone, then it can no longer drain into your axillary nodes, right, so what would be the point? Your docs plan is not something I understand well but the main thing is that YOU understand it, before lumpectomy.

You may try looking the procedure up at: www.nci.nih.gov Most of the info there is straight forward and informative and can be very helpful. Just go to "types of cancer", choose breast and follow the links from there.

Best wishes to you and remember, if you're not comfortable with something or feel that you don't understand it, it's your doctor's responsibility to address your questions and your responsibility to yourself to feel comfortable and confident about anything proposed, at any time. Things move very quickly and it's easy to feel rushed and pressured but don't let that stop you from questioning your docs about anything.

Will be thinking of you on the 5th and hope all goes well!

Love, light and laughter,
Ink

DiO · January 2005

I had SNB along with my lumpectomy 12/03. It was all outpatient--I went to the hospital about 5 hours before my surgery was scheduled for the nuclear injections, then home again until time to report for surgery. I found the injections painful, but bearable, and only hurt during the actual injection and stopped when the needle was removed. Not a fun procedure, but I've had worse!! The surgeon injected the dye in the or during surgery, so of course I didn't feel any of that. Good luck with your procedure, and best wishes for a happy healthy year.
God bless, Di

Roxi1 · January 2005

inkblot said:
Hi Roxanne:

What I did to cope was act ugly! LOL My radiologic injections, done prior to my lumpectomy, were painful but not unbearable. It took me by surprise as neither my surgeon nor the radiologist who did the injections said anything indicating the level of pain I could expect with the procedure. (you should mention your friends account of her experience to your surgeon and ask him/her about it)

My experience went like this: Morning of surgery, I was lying in the preop bed, talking with my husband. Had not yet received any medications. In comes the radiologist with a big smile. She explained that she would be doing 3 injections and pointed out where, each going in precise areas around my tumor, and that I'd feel the needle stick, followed by some pressure. She proceeded. The needle stick was no big deal but just seconds afterward, the feeling was far beyond "pressure". It was painful. It began with a slight burning sort of feeling and quickly became outright pain. As I responded to this, the radiologist (and her observer who was in tow), both looked at me as if I'd become the proverbial bug under the microscope! I believe my verbal response was something like: "Damnation this hurts, why didn't anyone tell me what to expect"? (the pain wasn't enough to cause me to swoon, however I was highly annoyed because I had not been properly informed) Although the radiologist seemed genuinely sympathetic and repeatedly apologized, it didn't help much really. The good news, at least in my experience, was that the pain only lasted about 10 minutes and began to dissipate. Then I felt only the pressure I'd been warned about. (I had both the dye and the radioactive tracer injected...some docs prefer one or the other while some prefer both, so whether one has "one or both" may play a role in the level of pain?)

I told my surgeon at my follow up visit, several days later, about the level of pain and he said that he was so sorry and that he would make it a policy to better prepare his patients in the future, etc.. He said that some have major pain while others have less. Since they see and acknowledge the pain most seem to experience during this procedure, are they ignoring it or have they assumed the "ignorance is bliss" approach?

My thought is that there's really no way to avoid the pain, otherwise something to lessen the pain would surely be utilized. Like everyone else, I fare far better when I'm prepared and know what to expect. (I typically prepare myself with some meditation and relaxation techniques and do quite well with most painful procedures) With this though, I was unaware and unprepared. Not a fair playing field to say the least.

As an aside: I don't know anyone who has had the sentinel node procedure, post lumpectomy. It's typically done at the same time as lumpectomy. Doctors have different philosophies though. Am wondering what other surgery you've had, prior to your upcoming lumpectomy? My thought is that since your initial surgical path report indicates invasive cancer, then why not do the sentinel procedure at lumpectomy? Once your tumor is removed, how could where it's draining be reliably mapped via sentinel node? Seems to me that if the tumor is gone, then it can no longer drain into your axillary nodes, right, so what would be the point? Your docs plan is not something I understand well but the main thing is that YOU understand it, before lumpectomy.

You may try looking the procedure up at: www.nci.nih.gov Most of the info there is straight forward and informative and can be very helpful. Just go to "types of cancer", choose breast and follow the links from there.

Best wishes to you and remember, if you're not comfortable with something or feel that you don't understand it, it's your doctor's responsibility to address your questions and your responsibility to yourself to feel comfortable and confident about anything proposed, at any time. Things move very quickly and it's easy to feel rushed and pressured but don't let that stop you from questioning your docs about anything.

Will be thinking of you on the 5th and hope all goes well!

Love, light and laughter,
Ink

Dear Ink,
I don't really know how the surgeon would do the sentinel node biopsy after the lumpectomy. But my husband and I both heard him mention it. But I have read at length about this procedure since then, and you are absolutely correct; it is almost impossible to do after a lumpectomy. so perhaps he isn't? Was a confusing visit, as both my husband and I went to the office that day, fully expecting the surgeon to tell us that the density with irregular borders seen on the mammogram (no speckling, no calcifications) was probably scar tissue from a terrible car crash we had been in May 04 (I had terrible bruising from the seat belt on my right breast, exactly where the mammogram was now seeing density). So, when the surgeon introduced himself, and then immediately said we needed to schedule surgery as it was 90% sure I had a malignancy.....He was adamant that what was seen on the US and mammogram was not from the accident. While I was in tears, my husband was listening to him discuss nodes and margins, etc. I had no biopsy, but the diagnosis from the imaging was BI-RAD 5, and that was conclusive enough to schedule an excision/lumpectomy and get the biopsy/path report after the fact.
So, there you go, am unsure about a lot of things.
Roxanne

seeknpeace · January 2005

Hi Rox,

When I had my snb, it was before surgery. The very morning of surgery, and I understand that they do it the day before sometimes too. I cannot understand them doing it after. If the path report is already indicating invasive cancer, my God why are they not doing the snb to coincide with the lumpectomy? The snb is to rule out metasteses through the node that is associated with your cancer, so that the node can be removed to inspect for cancer cells, as are any others that may look suspicious. To do a lumpectomy and then the biopsy is odd to me. And, requiring two procedures.

I had the snb the morning of my bilateral mastectomy and tram. It is a tool to detect spread and spare nodes that do not need to come out.

So, if they do the lumpectomy, and then they do the snb later and find enough evidence to warrant a mastectomy with the snb, that is three surgeries. I would ask him or her to explain the wisdom of their choices.

My snb hurt, but, nothing like my core needle biopsy. The cnb KILLED me. I sobbed through the entire thing and the doctor hit me with numbing again and immed started another, so it did not help. The SNB, that was not fun, but, I knew that it was the last thing before the big M.

Hang in there honey. This is a scary and uncertain time and the shock alone is debilitating to some of us. I wish that I would have had this site before my surgery, between diagnosis and surgery. I called the YME hotline and there was not one person to talk to me. The operator was mortified. I was sobbing and scared. Was awful. This site has helped me so much.

Rox ask them to do it before. I asked for mine. It was not a regular procedure for dcis, but, my dcis was very aggressive, the worst kind, so they could get it approved. But, I am the one who asked. My oldest daughter is in Nuclear med. and here visiting today. The only thing that should hurt is the prick of the needle. The actual isotope should not hurt. There is nothing in it to cause pain.

Jan

nancys · January 2005

Hello Roxi, I also had a sentinel node biopsy and an axillary node biopsy at the same time. My experience with it was that while uncomfortable, it was not really painful. My surgeon injected a painkiller first and then the dye. The area of the tumor margins was in the middle of my breast right below the nipple so that the injections were very near the nipple. After the injections were all through, I told the young girl watching the monitor that it was not really painful and she told me that it was sure painfull for her to watch. I would not be afraid to have it done again. I received the axillary node biopsy because the one node, the sentinel was positive for cancer cells while the other 13 removed were clear. The sentinel node is checked right away while they are doing the proceedure. Hope this helps. Hugs, Nancy

SusanAnne · January 2005

I haven't done much reading up on the snb (I had level 2 node disection) but my cousin is having prophylactic mastectomies on Tuesday and snb's will be done. Obviously a lump need not be present for the procedure. I think the sentinel node is the sentinel node regardless of whether cancer is present in the breast. Correct me if I'm wrong, please.
Susan

tlmac · January 2005

SusanAnne said:
I haven't done much reading up on the snb (I had level 2 node disection) but my cousin is having prophylactic mastectomies on Tuesday and snb's will be done. Obviously a lump need not be present for the procedure. I think the sentinel node is the sentinel node regardless of whether cancer is present in the breast. Correct me if I'm wrong, please.
Susan

You ask a really interesting question, Susan. My understanding of the sentinel node is that it's the first one cancer cerlls would travel to after leaving the tumor. That's why the dye is injected at the site of the tumor. The sentinel node would be different depending on where your mass is located. If there's no tumor, where is the dye injected and how do they know which is the sentinel node?
terri

Roxi1 · January 2005

tlmac said:
You ask a really interesting question, Susan. My understanding of the sentinel node is that it's the first one cancer cerlls would travel to after leaving the tumor. That's why the dye is injected at the site of the tumor. The sentinel node would be different depending on where your mass is located. If there's no tumor, where is the dye injected and how do they know which is the sentinel node?
terri

Would there be a space, where the tumor used to be? Or, if not a space, wouldn't they know via 'coordinates' (smile). Perhaps, they (whoever they are? surgeon? radiologist?) are not that graphically inclined to do coordinates. but certainly there is some way for them to know where the tumor had been. They could inject the dye in the same space? Don't some people have biopsies, esp the new vac core biopsies, which can take the entire tumor out? There would need to be a way of knowing where that tumor was to do the SNB, wouldn't there?
Guess I am so filled with questions, as the patient in the above case where the tumor is out, may be me.
I would also like to thank all the lovely ladies who took the time to respond to my question and offer their support. Although I have only been on this site for 2 wks approx., I can't say enough about the outpouring of warmth and support. Has given me the courage to add a real time support group in the community in addition to this one.
Thank you
Roxanne

seeknpeace · January 2005

Roxi1 said:
Would there be a space, where the tumor used to be? Or, if not a space, wouldn't they know via 'coordinates' (smile). Perhaps, they (whoever they are? surgeon? radiologist?) are not that graphically inclined to do coordinates. but certainly there is some way for them to know where the tumor had been. They could inject the dye in the same space? Don't some people have biopsies, esp the new vac core biopsies, which can take the entire tumor out? There would need to be a way of knowing where that tumor was to do the SNB, wouldn't there?
Guess I am so filled with questions, as the patient in the above case where the tumor is out, may be me.
I would also like to thank all the lovely ladies who took the time to respond to my question and offer their support. Although I have only been on this site for 2 wks approx., I can't say enough about the outpouring of warmth and support. Has given me the courage to add a real time support group in the community in addition to this one.
Thank you
Roxanne

When they do the procedure, they can leave markers in there so that they can identify the area, like when they do the core needle. They leave a metal marker so that IF it is cancer they can find the area easily for a lumpectomy.

With all that said, you would still have a shifting area from the removal and while there may be a space, why let them put you through two procedures? If the cancer is invasive, or not, there can be invasion that they cannot readily see, how many times have we read about that? And, honey, if they do the lumpectomy and they have not done the sentinel and they see invasive cancer, they have to cut you open again to do the sentinel. It makes no sense. The least number of times in the better for lots of reasons. When they see anything of a certain size and or grade, they do the sentinel. Also, I may would want a biopsy if they balk at the sentinel. It would definately determine if the sentinel is needed. Please ask for it first, before they do the lumpectomy. They need to know what they are dealing with before they go in, not later. Jan

inkblot · January 2005

Roxi1 said:
Dear Ink,
I don't really know how the surgeon would do the sentinel node biopsy after the lumpectomy. But my husband and I both heard him mention it. But I have read at length about this procedure since then, and you are absolutely correct; it is almost impossible to do after a lumpectomy. so perhaps he isn't? Was a confusing visit, as both my husband and I went to the office that day, fully expecting the surgeon to tell us that the density with irregular borders seen on the mammogram (no speckling, no calcifications) was probably scar tissue from a terrible car crash we had been in May 04 (I had terrible bruising from the seat belt on my right breast, exactly where the mammogram was now seeing density). So, when the surgeon introduced himself, and then immediately said we needed to schedule surgery as it was 90% sure I had a malignancy.....He was adamant that what was seen on the US and mammogram was not from the accident. While I was in tears, my husband was listening to him discuss nodes and margins, etc. I had no biopsy, but the diagnosis from the imaging was BI-RAD 5, and that was conclusive enough to schedule an excision/lumpectomy and get the biopsy/path report after the fact.
So, there you go, am unsure about a lot of things.
Roxanne

Just wanted to mention that neither the ultrasound nor the mammo. can render a conclusive diagnosis and also cannot predict invasive or DCIS. What it can do is give the radiologist a good idea of what your mass likely ISN'T. Even so, only a biopsy or surgical excision and the pathology report can determine precisely what it
is. How your doctor can know, with any degree of certainty at all, that it's cancer, amazes me. That he told you he's 90% sure it's cancer also amazes me. That's a heck of a lot to put someone through with no supporting pathology report whatsoever. A fluid filled cyst will typically efface upon compression during mammo, which is very helpful to radiologists, whereas fibroadenoma's (non cancerous solid masses) typically do not, nor does the typical cancerous mass. It's true that many cancerous breast masses grow similar to what you described with irregular borders...almost like teensie fingers going out from the center tumor. Yet some do not. Mine did not. It was perfectly round and smoothe like a tiny marble and wasn't well attached to anything, upon palpation. You can't KNOW (nor can your doctor) what's going on in there until you have either a path report in hand. It could be anything or nothing serious at all. Please keep that in mind.

The Bi-rad rating system is just that...a rating system. It doesn't diagnosis what a mass is;
just indicates that further exploration of the suspicious mass (via biopsy, surgery, etc.) is necessary.

It's all unnerving to say the least and all the more reason to try to learn all you can and research and ask questions of your doctor's. Your doc may well be thinking that even if your mass is nothing serious, that it needs to come out but most surgeons want to know what a mass is, whenever possible, prior to any surgery. Thus, the options of fine or core needles biopsies, etc.. Invasive simply means that the mass has broken out of the mammary duct. That doesn't mean that it's spread anyplace beyond the actual space it occupies in the breast. Invasive is a scary word but don't let it get you nuts at this point. It doesn't have to be large to have become invasive.

We've all been there and it's difficult to focus sometimes. We all understand how it feels and it's incredibly easy to not hear much of what a doctor has to say, beyond the word "cancer". A cocoon of terror and fear can ensue and it's as if the world around you just stopped spinning and it can feel like a big void with no sound... nothing registers and many women cannot recall how they even got home! You need some questions answered however, so just ring up your doc and let him know that you have questions and get scheduled back in there before your surgery. Take pencil and paper and make notes to help you remember it all. It'll be worth the effort and time because you will likely feel much more clear on what the plan is and can get your feet under you a bit better and feel more prepared for the surgery. I know it's only a few days time until your surgery date so maybe the doc could see you after his/her last patient of the day either tomorrow or Wednesday? My thought would be to ask him about a fine needle biopsy prior to any surgery at all because the pathology from that will be very informative to your doctor as well as yourself. If it should be a fibroadenoma, for instance, then no sentinel node procedure would be necessary and everyone would know this going into the surgery. If it is cancerous, then the sentinel can be done at the same time as the lumpectomy, saving you an additional surgery. The fine needle biopsy is the simplest of procedures in most instances. The needle can be a bit uncomfortable but nothing like a core biopsy. Your choice. Just realize that you do have some choices here and your doctor should be informing you of your options and explaining the pros and cons of each to you.

Stay positive and remember that it isn't cancer until a pathology report says so, inconclusively!
The all important path report can render just about everything about your tumor, except what caused it. Hormone neg or pos, aggressiveness, Her/2neu pos or neg.. A wealth of important info..

Please keep us posted and try to make time for relaxation. Well worth the planning and/or MAKING
yourself take the time out. You'll see.

Love, light and laughter,
Ink

inkblot · January 2005

SusanAnne said:
I haven't done much reading up on the snb (I had level 2 node disection) but my cousin is having prophylactic mastectomies on Tuesday and snb's will be done. Obviously a lump need not be present for the procedure. I think the sentinel node is the sentinel node regardless of whether cancer is present in the breast. Correct me if I'm wrong, please.
Susan

Hey SusanAnne:

If your cousin has no personal history of bc, or any problems, then I don't quite get the sentinel node procedure being done during her mast.

It comes to mind that perhaps the doc wants to
use it as an indicator during surgery, just in case anything is going on in either of her breasts that they're completely unaware of? Thinking it would show up in the sentinel node and they could then decide, during surgery, whether to remove more nodes for testing? Probably not a bad idea, assuming that the surgeon has done many sentinel nodes and is highly skilled and has a really good "find" rate. (At least 98%) Not all docs actually find the correct node, which is "sentinel", even with the dye and/or radioactive tracer. Just thinking out loud here. Still, it's far less invasive than the alternative of removing a whole level of nodes.

Wishing your cousin all the best!

Love, light and laughter,
Ink

SusanAnne · January 2005

inkblot said:
Hey SusanAnne:

If your cousin has no personal history of bc, or any problems, then I don't quite get the sentinel node procedure being done during her mast.

It comes to mind that perhaps the doc wants to
use it as an indicator during surgery, just in case anything is going on in either of her breasts that they're completely unaware of? Thinking it would show up in the sentinel node and they could then decide, during surgery, whether to remove more nodes for testing? Probably not a bad idea, assuming that the surgeon has done many sentinel nodes and is highly skilled and has a really good "find" rate. (At least 98%) Not all docs actually find the correct node, which is "sentinel", even with the dye and/or radioactive tracer. Just thinking out loud here. Still, it's far less invasive than the alternative of removing a whole level of nodes.

Wishing your cousin all the best!

Love, light and laughter,
Ink

Hi Ink. That is exactly why the surgeon did the snb's. My cousin does have LCIS, which, very recently, is being thought of more like a pre-cancer rather than just a marker increasing ones chances. The doctor has had instances in which she's gone in to do prophylactic mastectomies and actually found cancer. So yes, it was precautionary, just in case. I appreciate the well wishes for my cousin. I saw her off at the hospital this morning and waited until the breast surgeon came out when she was done with her portion. She said everything looked OK, nodes seemed clear and she found no masses. Of course pathology is needed to confirm that but she was optimistic. The plastic surgeon is working on her now and will be until about 9 pm (she is having bilateral DIEP flap reconstruction). I will go back to the hospital then.
Take care,
Susan

DanaS · January 2005

I am a new member of this group. I had exactly the same info as Roxi1, in November I had a lumpectomy and the doctor told me that I would need a sentinel node biopsy if the cancer was invasive. The biopsy was carcinoma in situ, and she said that that wouldn't require anything except a lumpectomy (no radiation, chemo, etc.).

Anyway, after a long story,(I had a second invasive cancer that was very close to margins, as well as the in situ at several of the margins) I needed another surgery to get adequate margins, and the sentinal node biopsy. I had the dye injected into the cavity, the injection itself stung a little. I honestly didn't think the dye was very painful, but then I ended up with a large incision for the second "lumpectomy (that's what it was called, even though there wasn't a lump anymore). I was very sore from the node biopsy site, but didn't really have any problems with the dye. It certainly wasn't a trip to hell (that description might be for the 2 needles I had placed for the lumpectomy, one under sonogram, and the other under mammagraphy).

Today, I had a medcath placed, since I start chemo on Thursday.

As a newbie to all of this, I'd love any advice anyone has.

Bottom line is the radioisotopes doesn't have to be a problem.

DanaS

DanaS · January 2005

Roxi1 said:
Would there be a space, where the tumor used to be? Or, if not a space, wouldn't they know via 'coordinates' (smile). Perhaps, they (whoever they are? surgeon? radiologist?) are not that graphically inclined to do coordinates. but certainly there is some way for them to know where the tumor had been. They could inject the dye in the same space? Don't some people have biopsies, esp the new vac core biopsies, which can take the entire tumor out? There would need to be a way of knowing where that tumor was to do the SNB, wouldn't there?
Guess I am so filled with questions, as the patient in the above case where the tumor is out, may be me.
I would also like to thank all the lovely ladies who took the time to respond to my question and offer their support. Although I have only been on this site for 2 wks approx., I can't say enough about the outpouring of warmth and support. Has given me the courage to add a real time support group in the community in addition to this one.
Thank you
Roxanne

I had the dye injected into the space where the tumor was, under ultrasound,like how the wire was placed, and they injected the dye into the same area as where the tumor was.

I suspect that whatever way the original tumor was located would determine how they decide where to inject the dye so that it finds the proper lymph nodes.

Dana

Roxi1 · January 2005

DanaS said:
I am a new member of this group. I had exactly the same info as Roxi1, in November I had a lumpectomy and the doctor told me that I would need a sentinel node biopsy if the cancer was invasive. The biopsy was carcinoma in situ, and she said that that wouldn't require anything except a lumpectomy (no radiation, chemo, etc.).

Anyway, after a long story,(I had a second invasive cancer that was very close to margins, as well as the in situ at several of the margins) I needed another surgery to get adequate margins, and the sentinal node biopsy. I had the dye injected into the cavity, the injection itself stung a little. I honestly didn't think the dye was very painful, but then I ended up with a large incision for the second "lumpectomy (that's what it was called, even though there wasn't a lump anymore). I was very sore from the node biopsy site, but didn't really have any problems with the dye. It certainly wasn't a trip to hell (that description might be for the 2 needles I had placed for the lumpectomy, one under sonogram, and the other under mammagraphy).

Today, I had a medcath placed, since I start chemo on Thursday.

As a newbie to all of this, I'd love any advice anyone has.

Bottom line is the radioisotopes doesn't have to be a problem.

DanaS

Update:
Yesterday I had wire localization (which was over before I realized it, and no pain at all; however the Radiologist said the pain was minimized, as the tumor so close to the surface). I questioned the Radiologist and the Surgeon, and both said they do sentinel node biopsies after WLE, when their was no previous biopsy. So, I don't know how they do this without a tumor present anymore, but it is not an uncommon occurrence. The pain associated with the lumpectomy was also minimal as pre-emptive analgesia was used 'to the max' (never heard of pre-emptive analgesia before, but seems to be the state of the art to minimize pain after surgery.
So, now I wait for the path report which should be in tomorrow. (crossing my fingers, and saying my prayers)

Sentinel Node Biopsy

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