Lymph node dissection following successful pre-operative chemo?

[tortue]

I've just completed eight rounds of dose-dense pre-operative chemotherapy for a diagnosis of stage II breast cancer (infiltrating ductal carcinoma) involving a 1.6 cm tumor in the left breast and 5-6 positive nodes in the left arm.  A recent PET scan, sonogram, and physical  examination indicate that I am currently "disease free," with no palpable nodes and a tumor that has decreased to 1.2 cm.  My medical team is recommending a lumpectomy, removal of two stages of the nodes as well as radiation to the breast and lymph node area.  However, they have also admitted that current research suggests that there may be no benefit in terms of increased life expectancy in dissecting the lymph nodes, particularly as I will also undergo radiation to this area.  Please advise whether there is any medical advantage to removing the previously diseased nodes and whether or not that advantage outweighs the risks and side effects involved with this kind of surgery.  Thank you for your soonest answer as I must make a decision about this fairly quickly.

[CCF-RN,MSN-rf]

Dear tortue:  The reason to remove the "previously" diseased nodes is to determine if there is residual disease.  It is unclear, based on the information you provide how the determination was made that there were 5-6 lymph nodes, presumably this is what could be felt - there may have been more that could not be felt.  There may not be evidence that this improves survival but it may be good information to help guide treatment decisions.  To some extent, advantages and risks will be technique dependent and also dependent on radiation.  Another option is to seek a second opinion from a second team who can make recommendations according to all the specifics of your case that cannot be appropriately analyzed via the internet.