BREAST CANCER COMMUNITY
Should lymph nodes be dissected even if PET-CT scan is clear?

Should lymph nodes be dissected even if PET-CT scan is clear?

My name is Maureen F., age 55, being treated for recurrent breast cancer.  In 1994 I had a very early stage invasive tumor (7mm) found by a mammogram.  I had a lumpectomy with no lymph node involvement (15 axillary nodes removed).  It was followed with radiation only.

Over 13 years later, in July 2007, suspicious calcifications were found during a mammogram of the same breast.  A stereotactic needle biopsy showed DCIS.  I used the same surgeon as I did in 1994, who said would have to do a simple mastectomy because I'd already had radiation, but no further lymph node dissection was needed, and I would not need to see an oncologist because the surgery would get it all, so I wouldn't need chemo.  He did, however, say the removed breast tissue is always required to be sent for pathology.  I proceeded to have the mastectomy on 8/20/07, with immediate TRAM-flap reconstruction.  I thought all was well.

Unfortunately, 1 1/2 weeks ago (3/17/08), I got a call from the surgeon, essentially saying he'd screwed up!  He never reviewed the path report following the mastectomy, and it showed I had a second focus of invasive cancer (1.5 cm) that was not caught by the biopsy.  Just by chance, he had gotten 4 lower lymph nodes with the tissue, and 2 of them were positive (macrometasatic with extranodal extension, largest measurement 0.6 cm).  The tumor was staged T1c N1 MX, had estrogen & progesterone receptors, & was HER-2 neg.

Since no one knows the impact of waiting 7 months before beginning treatment, I have been on a fast track since then: referred to an oncologist, and run thru the gamut of tests (MUGA heart scan, bone scan, CT of chest-abdomen-pelvis, and PET-CT total body scan.  All came back clear!  I am scheduled for chemo (Cytoxan & Taxotere) tomorrow morning (3/27/08).  The oncologist is also checking to see if I can later have additional spot-radiation to an area where the invasive cancer was close (5 mm) to the peripheral margin of the mastectomy.  I also will be put on an aromatage inhibitor after all this.

My one nagging concern is that the oncologist does not feel any need to look for &/or remove any remaining lymph nodes, because the PET-CT scan did not show any node inflammation.  What kind of information is out there about this?  Is this normal procedure, or is there an argument to inject dye, like in the sentinal node study, and take out what ever might be left to see if there is microscopic involvment that wasn't caught by the scan?  Or do we just hope the chemo will take care of it?  As you might guess, my faith that the right thing will be done is a bit shaken at this point!!  
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