Failed Sentinel Node Biopsy

[riesesdad]

My wife underwent a lumpectomy and Sentinel Node Biopsy 4 days ago for Invasive Ductal Carcinoma, 1cm tumor. She was injected with the Radioactive material at 10am and had the actual surgery at about 3pm that afternoon with the addition of the blue dye. The lumpectomy went fine, but they weren't able to find the Sentinel node (she specifically asked that they not do the Auxillary section).

How can they not find the Sentinel Node?
What are my wife's options now for finding the extent of the cancer, (assuming she won't get the auxillary section)?

Thanks

[CCF-RN,MSN-rf]

Dear riesesdad:  The option for evaluating lymph nodes now is to have the axillary lymph node dissection.  In general, surgeons remove only one layer of nodes and the complication rate is low compared with a full node dissection as done inthe past.  The question to discuss with her doctor is the value of pursuing additional surgery within the context of your wife's situation.

[Alexis in Virginia]

There are no rules in breast cancer and first you must have a surgeon that you trust and respect and who respects you.  If your wife doesn't have full confidence in her surgeon go get a second opintion or third until she finds one she really likes.  I have a GREAT surgeon and plastic surg at GW hospital and when I went into my mastectomy surgery 8 weeks ago for extensive DCIS and paget's symptoms the plan was to do a mastectomy w/ sentinal node biopsy, repair an old hernia (from previous c-section) and do a free-TRAM reconstruction.  I told my surgeon that I had full confidence in him and felt he understood and we agreed on treatment plan and approach so I told him straight out that if he found something else or in his judgement he needed to go further I expected him to make that judgement call and I approved it in advance.  I am 38 years old and have 2 children under the age of 5 years and my surgeon knows my primary goal is survival and getting rid of all the cancer!  I also would rather do it all in one surgery as I didn't want to have multiple surgeries if I could avoid it.  I was more worried about the anestesia than the surgery itself at that point.

Well 15 hours of surgery and they did find a 1.6 cm invasive cancer in my breast behind the nipple and my sentinal node was negative.  Yet while my surgeons were working they detected another swollen lymph node so they did a full auxillary dissection.  There was only the one swollen node positive for cancer but it was there.  My doc told me that was the first time it had happened but he thought that since that node was so full of cancer it had choked off the flow of lymph fluid so it didn't take the dye.  You can have more than one sentinal node as well.  The lymph system is like a series of streams which interconnect and when one or more stop working (as when you have some removed) others take over to compensate.  A good surgeon can do a very careful auxillary dissection with very minimal long-term side effects.  I regained almost full use of my affected arm within 4-6 weeks and while I still have some armpit swelling and stiffness I think it improves each week and it doesn't stop me from doing any of my normal activities with my children or house.

All my margins were clear and I am now in Chemotherapy and doing well.  I hope this helps but the bottom line is she must have a good doctor she trusts.  I switched surgeons in the beggining and was so thankful later that I had!
Alexis

[ritavv]

I was told that if your cancer is close to the sentinel node that the injection site becomes a 'hot spot' and can obscure the node.  They said they have more trouble when the cancer is close to the axillary area.  Could that have been her problem?

[surgeon]

the other options are to do a limited or more complete axillary dissection, meaning doing what was always done before the sentinal node procedure. In fact, taking the lower group of nodes is highly accurate, and is largely free of the complications of full dissection.

[riesesdad]

It's possible, but to tell you the truth, I just don't know. The tumor was prety high on middle area of the chest and close to the chest wall.