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Breast Cancer (Expert Forum)
Axillary dissection yields no nodes
Questions posted in the Breast Cancer Forum are answered by medical professionals from The Cleveland Clinic. Topics include Breast Biopsy, Chemotherapy, Hormone Therapy, Lumps, Lumpectomy, Lymph node dissection, Lymphedema, Mammograms, Mastectomy, Radiation Therapy, Reconstruction, Self Breast Exam, and Surgery.
Axillary dissection yields no nodes
by Sue B., Feb 22, 2004 12:00AM
Pathological grading described a wide arc of microcalcification encircling the upper and outer portion of my right breast as multifocal DCIS, predominately comedo type (high nuclear grade) with margins extending beyond the tissues collected. A mastectomy of the right breast with axillary lymph node dissection (SLN biopsy wasn't possible) and immediate TRAM flap reconstruction was done. A previously undetected 2.5 cm cancerous mass along with the intercostal brachial cutaneous nerve (engulfed by the mass) was removed from my lower armpit during the surgery. The lab report indicates that no lymph nodes were found in any tissue supplied to them. My general surgeon states that he removed tissue that normally would have yielded two-thirds of the axillary nodes and the surgeon doing the reconstruction and wound closure verified this. Per my oncologist’s request another hospital reviewed the tissue slides with like results. Could all the axillary nodes have been within that small 2.5 cm area and overrun with cancer cells to the point they were no longer microscopically identifiable- as my general surgeon is now speculating? His earlier conclusion was that I simply must not have had any axillary lymph nodes to be gathered. Everyone seems confused. How far out of the norm is this?
Doctor's Answer
by CCF-RN,MSN-rf, Feb 23, 2004 12:00AM
Dear Sue B: This is certainly unusual but there are certainly times when anatomy can be very different than expected. In my years, I have not personnally experienced this. Usually, when the "fat pad" is removed from the axilla, the lymph nodes are contained within. I suppose it is possible that they were overrun with cancer cells but one would think there would be some evidence that lymph nodes were once present. Very interesting.
