Centinal node biopsy after Chemo and mets

[corismom]

I have heard that if you have done chemo before surgery than you can’t do the sentinel node biopsy.  Is this true?  My surgeon says you can sill do it but you look at the results differently.  I'm confused.

Also, I have Triple Negative BC, my last chemo was three weeks ago and the MRI I took last week showed "a dramatic change from the last MRI before chemo," it does however also show a couple of spots that are 4mm and 9mm (both in the breast and in the nodes). Surgery is scheduled for next week followed by radiation (not sure when).  If the chemo didn't get all of the cancer cells, what kind of chance is there that the tumor will grow and spread in-between the last chemo and surgery And, between surgery and radiation.
Thanks!!!

[Fernando Roque, MD]

Hi.  When doing chemotherapy prior to surgery (called "neoadjuvant chemotherapy"), there is a chance that any tumor spread to the armpit nodes will get cleared by the chemotherapy.  Hence, doing the sentinel node biopsy after neoadjuvant chemotherapy may not yield reliable results - negative sentinel nodes may have been originally positive for cancer, but those cancer cells might have been killed off by the chemotherapy.  If neoadjuvant chemotherapy is performed, it might be better to sample more nodes during surgery, instead of just doing sentinel node biopsy.

Surgery is usually scheduled around 3-4 weeks after the chemotherapy to allow the body to recover from the effects of chemotherapy.  After surgery, another 3-4 weeks may be needed to allow the operative wound to heal fully, before radiation treatment is started.  There are no clinical studies investigating the probability of cancer spreading while waiting for the next treatment to be done, so I really can't give you any statistics on this.  However, from clinical experience, a 3-4 week waiting period between treatments has not resulted in disease progression or recurrence in the majority of patients I've treated.

[corismom]

Thank you so much for your input.  I asked my sergeon about the Sentinal Node Biopsy and she said that she will be doing that and removing lymph nodes.  She also said that the time frame inbetween chemo/surgery and sugery/chemo is not a long time where the cancer would grow back so quickly.