pathology after sentinal node dissection: no nodes present in sample

[web_lady]

I had a biopsy on 6/17 that led to a DCIS diagnosis. Went back on 6/24 for further tissue removal and sentinel node dissection. The surgeon called me a few days later  to say that the pathology showed the margins were clear and the tissue and nodes were negative for cancer. Reason for celebration, for sure.

But upon my review of the printed pathology reports, it said the margins were clear, but that no lymph nodes were present in the tissue presented to pathology. So -- how is it then, that my surgeon could tell me that the lymph nodes were clear?

I sure hate to think that I endured a very painful procedure that injected the radioactive dye into my nipples, for no reason at all. And that my underarm incision is still very painful one week later (though it is getting better, thank goodness.)

Is this a reason to be concerned -- that I still don't know if the lymph nodes are clear? I fear that if I bring this up to my surgeon she'll suggest that to be sure we could do the whole procedure again. Is this common for the nodes not to be in the sample? What are the stats on having DCIS and cancer cells in lymphs?

[healingwell62]

Try posting this on the Ask a Doctor forum and see what their answer is.  I'm also curious about this and don't understand why your path report would say that.

Chris

[web_lady]

Thank you Chris, I will keep trying to do that. It keeps saying, "The expert(s) in this forum accept a limited number of questions per day. You can try again tomorrow or search MedHelp for similar questions that may already have an answer."

I'll let you know what I find out.

[marydenise]

Since DCIS by its nature is non-invasive, I don't believe there would be any chance for cancer cells to be in the lymph nodes.

[web_lady]

Thank you for your answer marydenise, it does make me feel better that I'm *probably* clear. That's what I've read also -- but if that's the case, then why did I have to have that painful radioactive injection that shows where the lymph flows are, so she could remove the lymph nodes. My lumpectomy incision doesn't hurt near as much as my underarm incisision. (I'm sorry to vent, I'm frustratred that I'm left with this painful arm, and no pathology to show that it was worth it.)

If she thought it important enough to attempt the removal of lymph nodes, and worth the 65% chance risk of  lymphedemia, etc. then shouldn't she be concerned that no nodes were in the sample handed off to pathology?

[Rowena Santos, MD]

How are you? The treatment of DCIS is focused on removing all DCIS from the breast by surgically removing the involved area or the entire breast and preventing the development of more DCIS or invasive breast cancer in either breast. DCIS cells lack the biological capacity to metastasize, or spread elsewhere in the body, like cancer cells do. However, depending on the type of DCIS and how aggressive it is determines treatment options. I understand your worries about this but i think it would be best to discuss this with your doctor and keep all lines of communication open.With DCIS, regular follow-up is very important to prevent recurrence.

Take care and keep us posted. This link may be helpful: http://www.dcis.info/dcis.html

[web_lady]

Dr. Santos, thank you so much for responding to this. I am seeing my surgeon in a few hours. This is a learning experience and I'm on the part of the learning curve where I don't know what I don't know yet :)

Thanks :)
Pam

[Norah_Za]

I was diagnosed with DCIS last year in July. My surgeon didn’t think I need to have  sentinel node dissection done. I just did the lumpectomy. The pathology report showed no sing of invasion not even micro invasion which agreed with my surgeon decision. Then I did the radiation and now I am following up with mammogram, sonogram and MRI every six months. My DCIS was grade 3 and I have strong family history of breast cancer and I am just 46 even with all those facts I did not do sectional node dissection. I think the treatment to DCIS is different from one institute to another and one doctor to another. I had to go to three breast specialist and two of the three said no lymph nods. I am sure is the pathology reports showed any sign of invasive cancer they would have done the sentinel node dissection. My suggestion to you is if you do not feel comfortable get second or even third opinion. Good luck.
Norah

[web_lady]

Thank you to everyone who responded. I spoke with my surgeon yesterday and here is the answer:

Because of my age (49) and the grade of my cells (3), the attempt at lymph node biopsy or dissection was made, to save me from having yet another surgery, in case the DCIS was found to be more extensive; in additional areas; or more invasive during the lumpectomy.  It was a precaution. I'm fine with that. I appreciate being saved a potential third surgery in 3 weeks.

In my case, the lumpectomy was complete and there were no additional margins. They got it all.  My surgeon is reassuring me that the cancerous tissue has been removed and that it's highly unlikely in my case, that it spread to the lymph nodes, for the same reason everyone says here: DCIS in and of itself is not invasive.

My surgeon said she actually discussed my case at a weekly tumor meeting of about 20 other breast cancer professionals that meets in my community. It's rare, but sometimes nodes are not actually in the sample. The radioactive liquid must have settled in that area of the tissue.

Because there were no lymph nodes taken, I'm wondering if I'm actually fortunate here, in that I am at no or lessened risk for lymphedemia. I have a book that says you won't have perspiration odor after removal of lymph nodes in the underarm area, but since I can't put deodorant/antiperperant on my underarm, I have whopping odor coming from that area.

So there you have it, in case anyone else has something similar show up in their pathology. As long as your margins are clear on the lumpectomy, yes, it's ok that no lymph node are found in the sample. Whew.

[Rowena Santos, MD]

Hi Pam,
That's good to hear! :) It's never wrong to be vigilant with our health. Now you can concentrate more on your treatment options. Will you be having adjuvant therapies such as the radiation or chemo or just the lumpectomy? It is also helpful to find support groups in your area or in the web that can bring a sense of being understood.

Take care and regards.

[web_lady]

Thank you Dr. Santos! What I'm expecting to hear is that I need radiation therapy and then RX therapy.  In the next 2 weeks, I'll meet with an oncology md, and then with a radiation MD. I have not heard that I'd need chemo.

We have a great community cancer center in my area, and they have a great RN who is a "Breast Health Navigator" who met with me to give me lots of reading material on diagnosis, treatment and options.  She also gave me a heads up about depression being more serious after treatment is over, because you're not "doing" anything.

She gave me this great book called, "Your Breast Cancer Treatment Handbook: Your Guide to Understanding the Disease, Treatments, Emotions and Recovery from Breast Cancer". I wish I had this book from day one, because it explained a lot.

The Community Cancer center runs many different types of support groups, and I plan to join the breast cancer group. They also have a nutritionist on staff available for free, a large library and much more.

I will do whatever I have to, to be there for my 7 year old son, for as long as I can. Then, if I can give back to the breast cancer community in some way, it will give this whole experience so much more meaning. But I'm getting ahead of myself there, I'm just taking this one step at a time.