sentinel node biopsy as separate surgery

[Kando]

2/17/04 diagnosed with invasive lobular carcinoma, find no enlarged lymph nodes, have had ct scan, bone scan and find no metastisis, however, tumor is 5-6 cm.  Am considering neoadjuvant chemo followed by mastectomy then more chemo.  Concern is that neoadjuvant will make lymph node false negative, can a sentinel node biopsy be performed prior to chemo as a completely separate surgery to help stage the cancer?  And accurately state whether lymph nodes are involved?

[CCF-RN,MSN-rf]

Dear kando:  While a sentinel lymph node biopsy can be done as a separate procedure prior to chemotherapy, there may not be good reason to do this.  The questions to ask are:  1.  What will this information add to my care?  and 2.  What are the potential risks of doing 2 procedures?  

1.  The proposed reason to do the biopsy is for staging. If the biopsy is negative, you will need chemotherapy.  If the biopsy is positive, you will need chemotherapy.  So, it will not change the course of care.  Further, a sentinel node biopsy may not clarify the stage entirely as it only gives information on 1-3 nodes.  

2.  Whether you have sentinel lymph node biopsy, you will still be recommended to have a lymph node dissection when you have the mastectomy.  Having 2 procedures on the axillary lymph nodes will increase the risk of lymphedema.  This may not be a risk worth taking.

In summary, as the procedure will not change the recommendations for care but does increase risk for lymphedema, there may not be adequate reason to pursue the sentinel lymph node biopsy before chemotherapy.

[surgeon]

the biopsy certainly can be done as a separate procedure before beginning treatment. The question is whether it would alter your plan in any way: the treatment you describe is a sensible approach, and it doesn't seem that the status of the lymph nodes would affect it in any way. Which means, from a therapeutic point of view, there's no reason to get the info in advance; it's true that negative nodes found after treatment might reflect the effects of the chemo. But it wouldn't change the need to have had the chemo in the first place.

[Bet63]

Sorry for bothering you when you when you have so much going on, but do you mind my asking how your lobular carcinoma was diagnosed? I have read and heard from surgeons that it doesn't show up on mammo. The majority of info I can find is on DCIS and not so much on the lobular. Did you feel a lump and if so was it an obvious lump or more like a thickening? Thanks for any insight. Good luck with your chemo and mastectomy. Our thoughts and prayers are with you.
Take care.
Bet

[Kando]

I don't mind at all!  I found a lump in the upper portion of breast, not just thickening but an actual blob.  Went to breast center for mam - complaint of lump.  Mam, ultrasound and biopsy all same day (Friday).  Doc stated "looked and acted like" cancer.  Results from pathologist following Monday stated invasive lobular carcinoma.  Doc also stated this does not grow in the same way as ductal.  There is a site that I can't remember the name of but I typed in "lobular breast cancer" in GOOGLE and on about page three there was a site from i think university of utah that had "indian file"  which is apparently how this grows.  Hope this helps.