lymph node dissection vs. lymph node mapping

[indy60]

My surgeon has stated that he is more familiar with axillary lymph node dissection with my breast lumpectomy vs. the newer procedure of lumpectomy with sentinal node mapping and excision.  He has left the decision up to me.
Which is the best procedure as far as reducing my chance of missed cancer cells in axillary nodes?

Thank you for your kind assistance.

                                            Indy

[Cleveland Clinic]

Dear Indy:  In the not so distant past, axillary lymph node dissection was the standard of care and involved removing the lymph nodes in the fat pad under the arm (the number would vary based on the patient and the sentinel node – though not marked or identified – would likely be contained in the specimen).  Depending on the surgeon, additional lymph nodes may be removed but some would be left behind.  When sentinel node biopsy was discovered, the hope was that by looking at the first node that the tumor would “drain” to, removing additional nodes would be eliminated.  In reality, sentinel node biopsy and mapping has reduced the number of nodes that are removed in most cases.  However, mapping has shown that even when the sentinel node is negative, there have been metastases in nodes upstream (known as skip metastasis).  For this reason, many surgeons now identify the sentinel node (as this is still the most likely node to be positive) and then remove a small sample of the nodes upstream (ranges according to surgeon but may be in the range of 4-8).  This procedure would likely identify whether there are positive nodes in the majority of the population and may have the advantage of reducing potential complications such as lymphedema.  Of course, the correct procedure would also depend upon the specifics of any given situation (e.g. whether there are nodes that can be felt, the size of the tumor etc.).  You may wish to discuss this further with your surgeon and if you are concerned, consider a second opinion with another surgeon, preferably someone who specializes in breast surgery.

[japdip]

Well first of all you have a very honest surgeon ... if he is not experienced in the setinel node mapping and removal then by all means DO NOT have that done unless you are going to change surgeons. With the sentinel node procedure usually only one node is removed after a dye is injected to map it's location. With axillary dissection several (and the number varies with the surgeon) nodes are removed. I don't know that one is more reliable than the other; it's just that the sentinel procedure is less invasive. It does require experience though and I would never opt for that if my surgeon stated that he wasn't all that familiar with the procedure. So it's either the axillary dissection or find a Breast Surgeon who is experienced.

[katarina777]

You gave the very best answer, for sure, although Cleveland surprised me pleasantly by answering at all besides advising to speak to your doctor. In this specific case, the surgeon is the last one I would ask for advice. He already said everything. Indy60, the quality of the surgeon you have I think is the most important thing of all. He/she I think must have done over 30 of the sentinel node mappings to be at all qualified. Do not let this one surgeon practice on you if you can find a breast specialist, and otherwise the only option is what japdip already said.

All this would be difficult for me to do for myself, so if you are like myself, have a family member or friend do at least some of the communication or along with you, or otherwise talk to your other doctors, but don't discuss any more with this surgeon. he was indeed very honest.

Best wishes to you! kat