Lymph node biopsy v removal

Many thanks Victoria for your response to my query regarding MRI scans and lymph nodes.

Yes, I have been offered removal of a lymph node (or two) at the same time that I am having my lumpectomy.  However, isn’t it more logical to take a biopsy to test early on rather than remove a node later?  Am I missing a key piece of information to understand why the more risky and complicated procedure undertaken later rather than sooner is the preferred option?

Finally, I am considering undertaking part of my cancer journey privately - specifically, the surgery and pathology results - and returning to the NHS for radiotherapy. I live in the north of Scotland.  Is this permitted?  Could it lead to even further delays?  I am presently scheduled to start radiotherapy at the end of December so can’t imagine it should impact.  But your opinion would be welcome.

Thank you.

Tough

I got the impression that I was having a sentinel node biopsy done because the lymph nodes appeared to be of normal size on my ultrasound scan. 

@Tough just thought I’d respond as I asked a similar question about the SLNB when I was first diagnosed.

At the time of my mammogram an ultrasound was also done. As no lymph node involvement was identified in the ultrasound, they didn’t perform a biopsy (unlike in the breast where the mammogram picked up a lump, hence a biopsy).

At the results appointment when I was given my treatment plan which included a SLNB I asked why that was required when the ultrasound was clear and no biopsy was advised at the same time as the lump biopsy. The answer I was given was closely linked to NICE guidance for Invasive BC, when no lymph node involvement is identified in the ultrasound prior to surgery. I’m not sure if this is the exact reference in NICE - but it’s probably under the surgery section (1.4.1 looks closely related) of the guidance if you would like to take a look.

My interpretation was/is that if nothing unusual was identified during the initial ultrasound scan of the axilla then there would be nothing that the radiologist can perform a biopsy on at that point in time (unlike if they did see something suspect in the ultrasound). While the SLNB is termed a biopsy what I feel it really is, is a more accurate means to verify that the cancer hasn’t attempted to spread from breast to another part of the body via the sentinel lymph node(s) under the arm, by removing it and checking it’s pathology. A SLNB is performed under a general anaesthetic so that would be the reason why it’s being offered as part of the lumpectomy.

Thanks for your reply member. 

I’m still perplexed as to why the more straightforward and less invasive biopsy isn’t performed routinely on lymph nodes, regardless of the ultra sound result.  Yet the more potentially harmful (lymphoedema) and damaging  removal of the lymph node(s) is done instead during surgery. 

An early biopsy of the lymph nodes would allow treatment to start sooner (if anything is detected).  Why wait several weeks (in my case over two months!) to carry out the procedure? 

Hopefully a nurse can explain it to me.

Hi Tough 

Thank you for your further post. 

It is normal practice for a lymph node to be biopsied prior to surgery if any abnormal lymph nodes are identified on ultrasound.  A biopsy takes a small sample of the abnormal looking tissue to be looked at under the microscope.  This helps to plan surgery to the axilla as outlined on page 5 in theguidelines for breast cancer surgery in Scotland.  These guidelines are the same as the NICE guidelines in England mentioned by @TDG. As was the experience for @scientistamafier, people with normal looking lymph nodes on ultrasound would be offered sentinel node surgery  

When the lymph nodes look normal on ultrasound it is still important to confirm this by removing the sentinel node/nodes at the time of surgery to enable more accurate planning of future treatment. A sentinel node biopsy (excision of sentinel node) uses a small amount of radioactive material to identify the sentinel node (the first node cancer cells may spread to). This is then removed and checked to see if the node is clear of cancer cells.  Guidelines consider all the evidence about different treatments.  Recommendations are intended to ensure that people are treated most effectively while minimising the risk of treatments such as surgery to the lymph nodes. 

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