Sentinel Node Biopsy and a question

Sentinel Nodes
I cannot answer your question directly, but I can tell you that my surgeon informed me (right after the lumpectomy) that my sentinel nodes were clear, but that we had to wait about three days for the biopsy on the other nodes which were removed. This leads me to believe that there is always the possibility and that's why they biopsy all of the removed nodes. Hope this helps. Marilynn

Sentinel Nodes
A while back doctors theorized that lymph fluid drains from the breast through a series of nodes that would stretch like a line or a ladder if they were positioned end to end. Before this theory, they were thought to be more like a net with no discrete beginning but more like a flow in a general direction through a net-like arrangement. The development of new dyes and technology made it possible to inject dye into the breast and "see" (either with radioactive technology &/or with dark inks that you could physically see) which node the lymph fluid drained into first. The dyes "proved" the theory about the nodes draining more like a line or a ladder where you had to go by the first node before you came to the next one like going up a ladder. If there is cancer in a breast AND the cells have developed into something nasty that can set up camp elsewhere (that's what metastisis is), the first place that the cells stop and make camp is the nodes under the arm beginning with the first node they come to. This is the so-called sentinel node. If the cancer is NOT in the sentinel node, it probably isn't in any of the other nodes. The surgeon can check the sentinel node for cancer under a microscope for obvious cancer. If he sees any, he will remove several more nodes. The nodes are arranged in areas and usually the first level and often the second is removed to stage the cancer when the sentinel node is positive. If several nodes are found to be positive, the cancer is considered more aggressive. While this doesn't sound like great news, it is still better to know that than not know when you have aggressive cancer. Aggressive cancer demands aggressive treatment and failing to treat someone adequately can have serious consequences when we are talking about aggressive cancer. A surgeon experienced in doing sentinel node operations would not normally remove even just the first level of nodes if the sentinel node was negative. Cancer might possibly travel in another direction, but it is unlikely and you can be relatively sure of the results if your surgeon has lots of experience and usually gets good results. However, it takes time to develop compentency and surgeons don't dare miss cancer that is there. Beginning surgeons have to follow up a negative node operation with a standard dissection for lots of operations (I can't remember if it was 50 or 150 that they had to do but it is lots) from what I've been told just to develop competency. Um, my first surgeon was very nice but not experienced in this operation having done something like 12 of them and told me he would do a sentinel node operation but follow it up with a standard dissection. I switched after learning I had options.

When I woke up from my operation, I had a drain for the mastectomy that came out near under my arm but it was a drain for the mastectomy not the node operation. The surgeon said that the sentinel node was negative as far as he could see. I asked if I was "home free". He said no. The pathologist had to do frozen slices to check for micro-metastises. Fortunately, they came back negative too. I still had to go to the oncologist. If I had had a lumpectomy, he would have ordered radiation. Because of the mastectomy, I skipped that and went straight to medical treatment. The oncologist decided that since the nodes were negative and my tumors were small and they were estrogen positive, hormone treatment was sufficient. Obviously, they have to keep lots of stuff in mind to decide what is best. It gets confusing, so come back here and ask whenever you need to. Good luck at your appointment!

C. Abbott