Providing more options to patients with ‘delayed’ sentinel lymph node biopsy

In this week’s episode of ‘In conversation with…’ we spoke with Janel Powers, a high school teacher from New Jersey. In June 2020, Janel visited Monmouth Medical Center for a follow-up check on a small mass found six months earlier, and was told that the mass had developed into high-risk DCIS.

After consulting with her surgeon Dr Manpreet Kohli, MD, Janel decided to have the ‘delayed’ sentinel lymph node biopsy procedure with Magtrace® combined with a mastectomy, to allow for analysis of her high-risk DCIS before it was decided if underarm surgery was necessary. Unfortunately for Janel, it was.

During our discussion, Janel told us how she’d felt when offered the ‘delayed’ option, what it was like to have to go back for surgery and how she is doing now post-surgery.

Janel first visited Dr Kohli back in late 2019 after noticing the symptoms of a breast infection. Upon clearance of that infection it was noted that there was a small mass that wasn’t of initial concern but required monitoring.

A decision was made to keep monitoring it on a regular basis, but then things all changed when the COVID-19 pandemic struck.

“I was scheduled for a mammogram in March, but in March, we went on lockdown and I was afraid to go to the hospital at that point. COVID cases were through the roof.”

Eventually, in June 2020, Janel returned to Dr Kohli for a check-up on the mass. Unfortunately it wasn’t good news. “It concerned the radiologist at the breast center at Monmouth Medical Center, and he advised that I needed to have a biopsy.” Janel said.

During discussions with Dr Kohli and her family, Janel decided to undergo a bilateral mastectomy, as there were concerns around the safety of remaining tissue and she wanted to avoid any potential need to remove the other breast at a later date.

That’s when the unique technique of ‘delayed’ sentinel lymph node biopsy was proposed. This would involve Dr Kohli injecting the Magtrace® lymphatic tracer, then surgically removing the stage 0 breast cancer mass (DCIS) and sending it to pathology before a decision needed to be made on whether underarm surgery would be necessary.

“But if I needed to have the dissection, I knew that this procedure was going to allow her to find the lymph node very easily and to perform the operation without issue. And I was all for that. I was very supportive of that.”

Dr Kohli echoed this sentiment and explained how any form of surgery can carry its own risks, even techniques as proven as a standard sentinel lymph node biopsy.

“Saving the patient from a host of surgical related issues – it’s not bad for the patient and it’s certainly not a bad thing for the surgeon to avoid those risks too.”

With the ‘delayed’ sentinel lymph node biopsy technique, it’s now been established by numerous studies, including the SentiNOT study, that roughly 80% of women diagnosed with high-risk DCIS will not need further underarm surgery once the pathology results are returned.

However, Janel’s results found there to be an invasive component, and it was confirmed that a sentinel lymph node biopsy was required after all.

“Having to go back for another procedure was scary but you have to do it to make sure that you’re going to get through this.” she explained.

Despite the delay from injection to follow-up surgery, the long-life of the Magtrace® meant a strong signal could still be found in the underarm, allowing Dr Kohli to remove the necessary lymph nodes for further analysis.

“That’s the best news, just reaffirming that you did the right thing in trusting the process.” Janel said.

So were there any regrets at this chosen treatment path, undergoing the ‘delayed’ technique? “I think that for me what was most important was having that choice. It’s an emotional experience but I’m glad I did it. I’m glad that I took all of these steps.”

Now clear of cancer, Janel’s life is getting back on track, but she has this advice for any woman concerned about changes to their breasts:

“I am a poster woman for early detection and finding something so early on that, based on the lymph node being negative, I was spared a lot of the difficult treatments that come with later stage breast cancer.

So with other woman out there, I implore you to check early and regularly because it is the best news when you talk to the oncologist and he says, well, … you don’t need any follow up procedures.”

And for other women opting for a mastectomy alongside the removal of high-risk DCIS?

>> Find out more about ‘delayed’ sentinel lymph node biopsy and our ‘Save Our Nodes’ campaign

>> Enquire about adopting Magtrace® for your hospital

Note: ‘Delayed’ SLNB is currently only indicated for use in patients undergoing a mastectomy in the US.