Is Sentinel Lymph Node Biopsy Necessary for Breast Cancer? Guidelines and Research

[@karenayla449]

I had a double mastectomy surgery and 1 lymph node removed in June 2023 ( BRCA2 positive and I’m 43 yrs old) .My lymph node turned to have a cancer tumor inside. My tumor in my breast was under 2 cm, I had an invasive ductal carcinoma , stage 2 A. ER/PR positive , HER -2 negative . The after effect of surgery or the healing of the mastectomy , the side with lymph node that was removed was worse than the other side. So when I saw my oncologist, I insist on not going back to OR to have more lymph nodes removed. My oncologist did say, the treatment she planned on giving me will not change even if I have 1 or 2 or 3 lymph node removed. Will be going back to OR in January to have my breast expander change and Salphing0-oopherectomy. I think everyone also need to do their own research , listen to your doctor and make your own decision base on those information. We have to advocate for ourselves ... thank you for all the information, I been watching you since I was diagnosed.

[@yerbba]

Thank you for sharing your journey, and we appreciate your proactive approach to your treatment. It's important to gather information, communicate with your medical team, and make decisions that align with your values and goals. If you have any questions or would like us to cover a specific topic, feel free to let us know. Wishing you strength, resilience, and positive outcomes as you continue on your path to recovery.

[@alystyrejulian]

thank you for highlighting this clinical trial outside the US

[@yerbba]

Thank you for watching. We're glad you found this information helpful.

[@naththomas9946]

Thank you, Dr.Griggs, for promoting and supporting breast cancer 🙏🏽🙏🏽🙏🏽

[@yerbba]

Thank you so much for your kind words! It's truly heartening to know that our videos are making a positive impact.

[@gabrielavinteler7088]

I had ALND in 2022 following a SMX for ILC, I do not regret it as out of 12 lymph nodes, 7 were positive. Thank you for these weekly videos, very informative.

[@yerbba]

Thank you for watching and sharing your experience with the Yerbba community. We appreciate you!

[@naththomas9946]

Thank you, Dr Griggs, for your caring support.

[@yerbba]

We appreciate you! Thank you for watching.

[@lizzymartin6916]

My IDC

[@yerbba]

Thank you for watching and sharing your experience.

[@deborahholland-z3x]

Is the standard of care for diagnosis and staging different for women over 70? Should it be? Is this another example of ageism in medicine? Many women today over 70 are very healthy, productive, engaged in society, and living WELL independently (not as a frail invalid or burden to society) into their 90s or more. Shouldn't the decisions for ALL steps of breast cancer diagnosis and treatment be made jointly between the patient and surgeon/oncologist/radiologist? I am not seeing how age should be a determinant.

[@LindaLopez-i3r]

I interpreted the guideline of over 70 not needing a SNB (if clinically negative, small tumor) as not wanting to over treat. If the lymph nodes appear to be benign, the SNB is not needed. If 70 or over and starting endocrine therapy, perhaps the rationale is the AI will eliminate any possible, but unlikely cancer cells in the lymph nodes.

[@deborahholland-z3x]

I interpreted the same way. Study is interesting but the only definitive way to KNOW at this time if a suspected tumor is cancer or a lymph node is cancerous is a tissue biopsy as far as I know. Some women of ANY age may be willing to forgo sentinel node biopsy or not. Six years of f/u is very short as well in this study. Sounds like a lot more research is needed And not just based on age cutoff @@LindaLopez-i3r

[@yerbba]

You are correct. A biological cut off does risk under treatment. When we have large clinical trials showing no difference in outcomes or treatment, however, we can say with more confidence that a particular treatment could be omitted. It is possible that the same could be said for women under 70 years of age, but the studies have not been done in younger women. In this case, people over 70 have the advantage of clinical research.

[@agnessymon8869]

Interesting video. I'm 70 years old. Invasive ductal carrisnoma. Hr2 negative. Mri didn't pick up any lymph node problem. However during the mastectomy they did a sentinel lymph disection. It detected a cancer cell. I am i the process of chemo 8, rounds and radiation afterwards. If the radiation kills the cancer cells why is radiation necessary?

[@yerbba]

Thanks for writing. Radiation therapy kills the cells that are in the radiation therapy field, and chemotherapy works in other parts of the body. We hope this is helpful.

[@comradejensen418]

I believe node removal to be medieval in 2023. Inatstead returning to any sort of normality after surgery. Despite being grade 2 no node involvement. They took 10 I had no chemo nor radiotherapy. But as a consequence am rendered disabled. I have pain day and especially at night. My right arm and became reliant to gabapentin. I will NEVER have any further surgery ever. Living with life long pain is not a Life.

[@yerbba]

It sounds like you have had a really difficult time. Thanks for coming here and commenting. Wishing you relief.

[@comradejensen418]

I have left @SouthTees & referred to pain management for conductive tests & further Xrays now. I won't ever have anymore surgery that's me done. But I believe all patients should ask whether the surgeon is actually going to do the operation or be there at the beginning or end. If not walkaway.

[@naththomas9946]

Thank you, Dr. Griggs, for your very informative advice.

[@yerbba]

Thank you for tuning in! Your continuous support is truly valued and appreciated by our community.

[@mrking695]

I wish I’d known that about 70 year olds. Ultrasound showed nothing abnormal. I wasn’t told I had a choice and had sentinel node biopsy. Now I have an infected seroma and on antibiotics.

[@yerbba]

The field is always changing, so it's possible that, at the time you were treated, sentinel node biopsies were still being recommended. Thanks for writing.

[@mrking695]

@@yerbba it was in December 2023.

[@dianallerahurlburt9010]

Hi - Thanks so much for providing up to date information on new studies. It is really helpful. Can you provide the reference for the study you mentioned in the video that was conducted in Europe and Chile that showed no significant difference in recurrence or survival in both groups of younger women with or without node assessment? I am interested in reading the details. Thanks again from bringing new information to patients!!!

[@yerbba]

Thank you for your kind words! We're glad you found this information helpful. The study that was referenced can be found here: jamanetwork.com/journals/jamaoncology/fullarticle/2809872.

[@LindaLopez-i3r]

So interesting and informative - thanks for covering! Though clinically negative, I did have one positive node found at the time of surgery biopsy. You can never play these situations 2 ways, but I do wonder if endocrine therapy would have had the same result as SLN biopsy. My ER score is 100.

[@yerbba]

Such a good question, and you're right...we can't go back in time (or forward, for that matter).

[@Barbara-ex3ge]

Another very informative video thanks. I had a sentinel biopsy during surgery for DCIS 8 years ago in NZ and this year for HER2 positive 2.5cm tumour (no indication of spread to lymph nodes in scan, physical exam or SNB) in France this year. I am 71 so interested to know why not doing a sentinel node biopsy is only for ER/PR HER2 negative - not all types of cancer?

[@yerbba]

In some people with ER- and PR-positive breast cancer, having a positive lymph node would not change their treatment. When a test won't change the treatment, we consider not doing the test. This is the case with sentinel node assessment in people with ER/PR-positive breast cancer because we would recommend endocrine therapy regardless of lymph node status. In people with ER/PR-negative breast cancer, we do recommend doing lymph node assessment.

[@danakennedy5072]

Im 59, recently diagnosed with IDC, 1.9 cm. Im scheduled for an MRI with contrast, then a surgical consult. Im very scared about the lymph node situation. I plan to ask for bilateral mastectomy, but i dont want chemo/radiation.

[@yerbba]

We're sorry to hear about your recent diagnosis, and it's completely understandable and normal to experience feelings of fear and uncertainty. Discussing your concerns, including the preference for a bilateral mastectomy and your wish to avoid chemo/radiation, with your healthcare team during the upcoming consultations is a crucial step. The MRI will provide more information about lymph node involvement. Remember, you have the right to advocate for a treatment plan that aligns with your preferences. Seeking support from friends, family, or support groups can also be beneficial during this challenging time. Wishing you strength as you navigate through this process.

[@rebeccaherder8296]

Very interesting. Thanks for sharing that study. Ultrasound showed 3 lymph nodes positive on me but analysis after surgery showed only 1. Didn't change my treatment, but my sister had no positive lymph nodes and has done much better than I. Both ER+ HER2- but I was grade 3 high oncotype she was grade 1 low oncotype. Even now, she worries 12 years out that she didn't get enough treatment. American thing, I guess. My onc keeps saying recurrence is rare. Will you please do a video on long term recurrence of ER+ HER2-?

[@yerbba]

Thanks for taking the time to share your story. Yes, we will add this suggestion to our list and appreciate the idea.

[@irene1182]

I had TNBC and had two sentinel nodes removed at masectomy which thankfully were okay. I definitely would have wanted these tested for peace of mind. I’m in Scotland 🏴󠁧󠁢󠁳󠁣󠁴󠁿

[@yerbba]

For triple-negative breast cancer, having a sentinel node biopsy is still the standard of care.

[@gabrielasaez9601]

Very interesting indeed. Thank you so much!!

[@yerbba]

Thank you for watching! We're glad you found this video helpful.

[@lalithasridhar6455]

Very interesting. Thank you

[@yerbba]

You're very welcome! We're glad you found this video interesting.

[@cyn5490]

I am soon to be 75 and after my biopsy was graded I IDC, ER/PR+Her2- . My surgeon will do an SLNB but she seemed to think it was unnecessary . After hearing all the side effects I'm thinking of canceling and just have my lumpectomy and after care. ( surgery in mid Nov. 2024) I wondered if you know more in October 2024? You have calming presence and your explanations are superb ! Many Thanks!

[@yerbba]

Thank you for your kind words! It’s natural to feel uncertain, especially with concerns about side effects. Sentinel lymph node biopsies help determine if cancer has spread to the lymph nodes, but it’s best to weigh the benefits and risks with your surgeon and oncologist. If you’re in the U.S., consider visiting Yerbba.com for your personalized breast cancer report for personalized insights; it help provide insights on pros and cons for this and other treatment choices.

[@moisescosta2799]

Good night, doctor. Could you mention which 2 studies you mentioned in this video? thanks

[@yerbba]

Thank you for watching, this link contains information on the studies we mentioned www.breastcancer.org/research-news/no-lymph-node-surgery-for-small-breast-cancers

[@ninalifely4585]

Can you give the references for the two studies you cite? Thank you

[@yerbba]

Here's a link to the study we were referencing: www.ncbi.nlm.nih.gov/pmc/articles/PMC10514873/.

[@riverinavalleyfarmsllc3373]

Do you know anything about vitamin c iv therapy on HER2+? Thanks

[@yerbba]

Thanks for the question. There is no consistent evidence that vitamin C is helpful. If you're asking about safety, HER2-directed therapy is not known to work through oxidation.

[@riverinavalleyfarmsllc3373]

@@yerbba Well, we are doing a 100 grams every other day. Is is the golden ticket in her2+? No. But I would personally recommend at this moment for anyone that has cancer of any sort to try high doses of vitamin C. The quality of life is much better. This is what we have noticed so far. I don't understand why the medical community hates vitamin C. Thank you for your reply

[@CristinaJohnson-d4s]

Thank you

[@yerbba]

Thank you for watching and being part of the Yerbba community!

[@drlavanyavinukonda953]

What about HER 2 positive with internal mammary node involvement at the age of 49?

[@yerbba]

Great question. With HER2-positive disease, the likelihood of lymph node involvement is higher, and at this young age, lymph node assessment is likely to be recommended. The clinical study we reviewed was done in people with so-called "favorable" breast cancer.

[@QuixoticBlackCat]

What if you have a low burden of resideual disease in a positive LN after NET (neoadjuvant endocrine therapy) or pCR after NET or NCT, do you still have to have the lymph node removed?

[@yerbba]

This is an area of controversy to be honest. Asking your team what they think is the yield of lymph node removal may be helpful in making a decision.

[@QuixoticBlackCat]

@@yerbba ​ Of course, I already asked my team. I was trying to broaden this dialogue by asking you. I also am aware it is a controversy. I hope you do a program on this and include more controversial topics in the program. The program is too basic and safe most of the time right now to be very useful to most of us in the BC community. We need you to manage complexity better. I am thinking of leaving in a node that had biopsied positive for cancer and was palpable prior to treatment. It is now back to normal, no longer palpable and scans show it has returned to normal. I have grade 1 hormone positive BC. It is likely I have had it a long time before it was detected, maybe 10 years my surgeon said. It is very slow growing and non-aggressive, and has responded almost completely to treatment with NET and CDK 4/6 inhibitor. My primary mass has shrunk almost 70% prior to surgery as well, downstaging me from a T3 to T1. My ctDNA tests are negative and my CA 15.3 and CA 27-29 tests are all negative. They think this is because it is grade 1 and more indolent and treatment is working. I don't see what benefit there would be in a case like mine to take out this lymph node evenif it has micromets left in it. It is likely the cancer has been out and shedding millions of CTCs into my system for years before discovery. Cutting out my lymph nodes won't stop this and there may be others. You cannot cut all my lymph nodes out and this will be treated ongoing with a decade of adjuvant hormone therapy in my case. Also, my understanding is that they only take lymph nodes when they are trying to see if you need adjuvant chemo. Since we already know I have a positive node this diagnostic is not necessary. Also instead of cutting it out completely, biopsy would leave me with less chance of lymphedema and be thus preferred. Here are just some of the resources on this topic I found fascinating for the purpose of further discussion >> "Per the presented algorithms, omission of ALND should be considered for these HR-positive early breast cancer patients who have a low burden of residual nodal disease following NET." www.cancernetwork.com/view/strategies-to-optimize-axillary-surgery-in-patients-with-breast-cancer-receiving-neoadjuvant-endocrine-therapy "In a retrospective survival analysis of 4496 patients from the National Cancer Database who received NET for cT1-3N0-1M0 breast cancer between 2010 and 2016, Kantor et al. reported that survival of NET-treated patients mirrored that of upfront surgery patients [38], suggesting the possibility of considering de-escalation of axillary management strategies in NET patients." www.mdpi.com/2072-6694/13/4/902

[@QuixoticBlackCat]

@@yerbba ​ Of course, I already asked my team. I was trying to broaden this dialogue by asking you. I also am aware it is a controversy. I hope you do a program on this and include more controversial topics in the program. The program is too basic and safe most of the time right now to be very useful to most of us in the BC community. We need you to manage complexity better. I am thinking of leaving in a node that had biopsied positive for cancer and was palpable prior to treatment. It is now back to normal, no longer palpable and scans show it has returned to normal. I have grade 1 hormone positive BC. It is likely I have had it a long time before it was detected, maybe 10 years my surgeon said. It is very slow growing and non-aggressive, and has responded almost completely to treatment with NET and CDK 4/6 inhibitor. My primary mass has shrunk almost 70% prior to surgery as well, downstaging me from a T3 to T1. My ctDNA tests are negative and my CA 15.3 and CA 27-29 tests are all negative. They think this is because it is grade 1 and more indolent and treatment is working. I don't see what benefit there would be in a case like mine to take out this lymph node evenif it has micromets left in it. It is likely the cancer has been out and shedding millions of CTCs into my system for years before discovery. Cutting out my lymph nodes won't stop this and there may be others. You cannot cut all my lymph nodes out and this will be treated ongoing with a decade of adjuvant hormone therapy in my case. Also, my understanding is that they only take lymph nodes when they are trying to see if you need adjuvant chemo. Since we already know I have a positive node this diagnostic is not necessary. Also instead of cutting it out completely, biopsy would leave me with less chance of lymphedema and be thus preferred. Here are just some of the resources on this topic I found fascinating for the purpose of further discussion >> "Per the presented algorithms, omission of ALND should be considered for these HR-positive early breast cancer patients who have a low burden of residual nodal disease following NET." www.cancernetwork.com/view/strategies-to-optimize-axillary-surgery-in-patients-with-breast-cancer-receiving-neoadjuvant-endocrine-therapy "In a retrospective survival analysis of 4496 patients from the National Cancer Database who received NET for cT1-3N0-1M0 breast cancer between 2010 and 2016, Kantor et al. reported that survival of NET-treated patients mirrored that of upfront surgery patients [38], suggesting the possibility of considering de-escalation of axillary management strategies in NET patients." www.mdpi.com/2072-6694/13/4/902

[@QuixoticBlackCat]

@@yerbba My team is leaving it up to me.

[@nayegomez4391]

My mom had double mastectomy 2 weeks ago for DCIS on right breast. Final pathology showed Stage 1, grade 1 IDC that we did not know about on left breast (which we thought had no cancer) Which means that no lymph nodes were removed on left side. Can she still get a sentinel lymph node removed if there’s no more breast? I’m so scared 😭😭

[@yerbba]

It’s understandable to feel scared after your mom’s surgery revealed unexpected findings. Even without the breast, sentinel lymph node biopsies can sometimes still be performed to check for cancer spread to the lymph nodes. The injection(s) can be made into the surgical scar. If the tumor was small and your mother is over 70 years, we have good data that a lymph node assessment does not need to be done. Wishing all of you the best.