Appropriateness of Lumpectomy / Sentinel Node Biopsy (Case)

March 25, 2002 Ultrasound: 10x12 mm oval ecopoor nodule upper right breast, 12 o'clock position.

April 2002 Needle biopsy: "Infiltrating carcinoma which shows moderate nuclear pleomorphism, scanty mitoses and rare tubles corresponding to a grade 2 carcinoma.  There are foci of mucinous differentiation, of calcificatgionn, of intraduct carcinoma, and of single file infiltration and intravascular growth."

Immunostaining: "Estrogen receptor (clone 1D5) showed strong staining.  90% of invasive tumor cells were positive. Progesterone receptor (clone PgP636) showed strong staining.  20% of invasive tumor cells were positive.  An E-Cadherin stain is positive supporting a diagnosis of ductal carcinoma."

May 10 Chest X-Ray, Isotope bone and Ultrasound Abdomen tests all negative, including upper abdominal lymphhadenopathy.

My sister (45) has been advised to obtain a full mastectomy and auxiliary clearance by the same foreign hospital team that last year advised my youngest sister (37)with only DCIS to undergo the same prodeedure.

Questions: Based on current statistical data on survival rates, would a lumpectomy and sentinel node biopsy also be appropriate in this circumstance (given the available information) instead of the radical mastectomy?  Would additional tests be necessary before making this decision?  Would the information from the sentinal node biopsy be important for contemplating possible future actions, including more extensive surgery?  Is it not appropriate to undergo a proceedure of whichever type on a timely basis

[CCF-RN,MSN-rf]

Dear Retriever:  Based on what you have written, your sister has a 1 cm cancer that is estrogen and progesterone receptor positive.  I can't tell for sure, but is sounds as though the margins may be positive, making additional surgery necessary.  Whether or not a lumpectomy can be successful depends upon the size of the nodule, the size of the breast tissue (in order to produce a cosmetically acceptable result), and the patient's willingness/ability to proceed with radiation therapy after surgery (a lumpectomy must be followed by radiation therapy to be successful).  If there is any evidence of multifocal disease, a mastectomy is recommended.  In terms of sentinel lymph node biopsy, it is not recommended as a mainstream procedure.  In some very selected cases it can be done.  But an axillary node dissection is recommended in most cases.  In either case there is time (several weeks) to make a good decision but one should not procrastinate for months.

[annied]

Are there areas of the US where doctors are much more likely to do mastectomies rather than lumpectomies? Even when it's not necessary? I've heard that that's true in North Carolina and other areas in the south. Why would a doctor recommend mastectomy for a DCIS? That seems unnecessary.

[Redbean]

I had a double mastectomy when they found a 1.5 cm tumor in my left breast.  I insisted on the double mastectomy and they found cancer in my other breast which did not show at all on mammogram.